Provider Demographics
NPI:1023095700
Name:SUBURBAN ORTHOPEADIC AND MEDICAL CENTER LLC
Entity type:Organization
Organization Name:SUBURBAN ORTHOPEADIC AND MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZZOLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-483-2277
Mailing Address - Street 1:554 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-1338
Mailing Address - Country:US
Mailing Address - Phone:973-483-2277
Mailing Address - Fax:973-483-4577
Practice Address - Street 1:554 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-1338
Practice Address - Country:US
Practice Address - Phone:973-483-2277
Practice Address - Fax:973-483-4577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-23
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03332111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID NUMBER
NJU41992Medicare UPIN
NJ742904Q97Medicare ID - Type Unspecified
NJ065540Medicare ID - Type UnspecifiedGROUP NUMBER