Provider Demographics
NPI:1194736470
Name:RIZZO, ANTHONY JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:RIZZO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 HOWELLS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-5309
Mailing Address - Country:US
Mailing Address - Phone:631-666-1956
Mailing Address - Fax:631-666-1957
Practice Address - Street 1:200 HOWELLS RD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-5351
Practice Address - Country:US
Practice Address - Phone:631-666-1956
Practice Address - Fax:631-666-1957
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225776207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02587924Medicaid
NYP00231452OtherMEDICARE RAILROAD
NYP00231452OtherMEDICARE RAILROAD
NY8Q7161Medicare PIN