1316949175 NPI number — KAREN LYNN RIZZO DC

Table of content: KAREN LYNN RIZZO DC (NPI 1316949175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316949175 NPI number — KAREN LYNN RIZZO DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIZZO
Provider First Name:
KAREN
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

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:
1316949175
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/22/2006
NPI Reactivation Date:
03/28/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 HARMONY RD
Provider Second Line Business Mailing Address:
SUITE 25
Provider Business Mailing Address City Name:
GIBBSTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08027-1723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-224-0300
Provider Business Mailing Address Fax Number:
856-224-1412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 HARMONY RD
Provider Second Line Business Practice Location Address:
SUITE 25
Provider Business Practice Location Address City Name:
GIBBSTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08027-1723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-224-0300
Provider Business Practice Location Address Fax Number:
856-224-1412
Provider Enumeration Date:
08/11/2005

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: 111N00000X , with the licence number:  DC005230L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 38MC00434800 , 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: 0817029000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7256108 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1846558 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 66952316 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 556957 . This is a "AETNA USHC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223388183 . This is a "HORIZON" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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