Provider Demographics
NPI:1770645129
Name:RIZOS, GEORGE MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MICHAEL
Last Name:RIZOS
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 1:390 MERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-2701
Mailing Address - Country:US
Mailing Address - Phone:516-489-2212
Mailing Address - Fax:516-489-5132
Practice Address - Street 1:390 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2701
Practice Address - Country:US
Practice Address - Phone:516-489-2212
Practice Address - Fax:516-489-5132
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXOO39451111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO-39451-5OtherWORKERS COMPENSATION
NY60488OtherGHI
NYP644864OtherOXFORD
NYCO-39451-5OtherWORKERS COMPENSATION
NYX20961Medicare ID - Type Unspecified
NYX20962Medicare ID - Type Unspecified