Provider Demographics
NPI:1982679791
Name:RIZZO, VITO JOSEPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:VITO
Middle Name:JOSEPH
Last Name:RIZZO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BRENTWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:631-666-8100
Mailing Address - Fax:631-665-2227
Practice Address - Street 1:24 BRENTWOOD ROAD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-666-8100
Practice Address - Fax:631-665-2227
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003481213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00731411Medicaid
NYP36331Medicare ID - Type Unspecified
NY00731411Medicaid