Healthcare Provider Details

I. General information

NPI: 1083645535
Provider Name (Legal Business Name): CHRISTOPHER J RIZZO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 GLENRIDGE RD
GLENVILLE NY
12302-4523
US

IV. Provider business mailing address

79 GLENRIDGE RD ATTN BUSINESS OFFICE FOR MEDICAID
GLENVILLE NY
12302-4523
US

V. Phone/Fax

Practice location:
  • Phone: 518-952-8142
  • Fax:
Mailing address:
  • Phone: 518-952-8142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number230421
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: