Provider Demographics
NPI:1629004825
Name:RIELLO, ANTHONY (DC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:RIELLO
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 1:11 PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3562
Mailing Address - Country:US
Mailing Address - Phone:732-840-8422
Mailing Address - Fax:732-840-8442
Practice Address - Street 1:11 PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3562
Practice Address - Country:US
Practice Address - Phone:732-840-8422
Practice Address - Fax:732-840-8442
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC05027111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U66871Medicare UPIN
NJ904264Medicare ID - Type Unspecified