1487618427 NPI number — ANTHONY J RIZZETTA DO

Table of content: ANTHONY J RIZZETTA DO (NPI 1487618427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487618427 NPI number — ANTHONY J RIZZETTA DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIZZETTA
Provider First Name:
ANTHONY
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487618427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 EAST NEW YORK AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERS POINT
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08244-0593
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-653-3500
Provider Business Mailing Address Fax Number:
609-926-4311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 EAST NEW YORK AVE
Provider Second Line Business Practice Location Address:
SHORE PHYSICIANS
Provider Business Practice Location Address City Name:
SOMERS POINT
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08244-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-653-3500
Provider Business Practice Location Address Fax Number:
609-926-4311
Provider Enumeration Date:
04/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  25MB06006800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P01097434 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0739807000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1036538 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: P380303 . This is a "OXFORD HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00730435 . This is a "RR MEDICARE (CAPE)" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1980137 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6330509 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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