Healthcare Provider Details

I. General information

NPI: 1083583470
Provider Name (Legal Business Name): DIANA TERESA RIZZO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 LENOX AVE
NEW YORK NY
10037-1802
US

IV. Provider business mailing address

116 HAYES ST
BLAUVELT NY
10913-1816
US

V. Phone/Fax

Practice location:
  • Phone: 212-939-2250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number034916
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: