Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | X0097811 | NY |
NPI | 1003948472 |
---|---|
Provider Name | Dr. Robert J Rizzo JR. |
First Address | Farmingville, NY 11738-4205 |
Second Address | Farmingville, NY 11738-4205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 25/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C097818 | NYS WORKERS COMP (01) | |
U82523 | (02) |