Provider Demographics
NPI:1326113804
Name:RIZZITELLO, NICHOLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:RIZZITELLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CLINTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111
Mailing Address - Country:US
Mailing Address - Phone:973-374-2456
Mailing Address - Fax:973-374-0708
Practice Address - Street 1:1200 CLINTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111
Practice Address - Country:US
Practice Address - Phone:973-374-2456
Practice Address - Fax:973-374-0708
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00159000111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1385208Medicaid
NJT45206Medicare UPIN
NJ451453Medicare ID - Type Unspecified