1164518742 NPI number — JOHN SAMUEL RIZZO M.D.

Table of content: RYAN TRUNG-DINH TRUONG (NPI 1336835107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164518742 NPI number — JOHN SAMUEL RIZZO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIZZO
Provider First Name:
JOHN
Provider Middle Name:
SAMUEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1164518742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 MORTON AVENUE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
RIDLEY PARK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-521-2111
Provider Business Mailing Address Fax Number:
610-521-3048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 MORTON AVENUE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
RIDLEY PARK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-521-2111
Provider Business Practice Location Address Fax Number:
610-521-3048
Provider Enumeration Date:
10/04/2006

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: 207W00000X , with the licence number:  MD021260E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 31269A . This is a "KEYSTONE MERCY HEALTH PLA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4131201 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0008385580001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6424861B . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0031054000 . This is a "IBC-KEYSTONE HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 180010183 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: PS44146 . This is a "OXFORD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 166019 . This is a "IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 36784000 . This is a "DAVIS VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: P47921001 . This is a "MULTIPLAN" identifier . This identifiers is of the category "OTHER".




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