Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 25MA07113100 | NJ |
NPI | 1184645608 |
---|---|
Provider Name | Dr. Louis Rizio III |
First Address | Livingston, NJ 07039-4532 |
Second Address | Livingston, NJ 07039-4532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 17/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25MA07113100 | STATE LICENSE (01) | NJ |
H22917 | (02) | NJ |