Healthcare Provider Details

I. General information

NPI: 1285778258
Provider Name (Legal Business Name): JAMIL F RIZQALLA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 WEST MOUNT PLEASANT AVE
LIVINGSTON NJ
07039
US

IV. Provider business mailing address

651 W MOUNT PLEASANT AVE
LIVINGSTON NJ
07039-1600
US

V. Phone/Fax

Practice location:
  • Phone: 973-740-0607
  • Fax: 973-740-9895
Mailing address:
  • Phone: 973-740-0607
  • Fax: 973-740-9895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101015686
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number245032
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: