Provider Demographics
NPI:1841242252
Name:RIZKALLA, MICHAEL (OTR)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:RIZKALLA
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 HWY 35
Mailing Address - Street 2:UNION SQUARE PLAZA
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07701
Mailing Address - Country:US
Mailing Address - Phone:732-219-5700
Mailing Address - Fax:
Practice Address - Street 1:588 HWY 35
Practice Address - Street 2:UNION SQUARE PLAZA
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07701
Practice Address - Country:US
Practice Address - Phone:732-219-5700
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00062000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ038506Medicare ID - Type Unspecified
NJP08182Medicare UPIN