Provider Demographics
NPI:1477717791
Name:RIZKALLA, MICHAEL H (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:RIZKALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 K JOHNSON BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-2251
Mailing Address - Country:US
Mailing Address - Phone:609-817-0050
Mailing Address - Fax:609-588-8602
Practice Address - Street 1:9500 K JOHNSON BLVD
Practice Address - Street 2:STE 1
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-2251
Practice Address - Country:US
Practice Address - Phone:609-817-0050
Practice Address - Fax:609-588-8602
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAL-236339208100000X
NJ25MA089229002081P2900X, 2081S0010X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine