Healthcare Provider Details

I. General information

NPI: 1023377579
Provider Name (Legal Business Name): JESSE RIZKALLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 PORTLAND AVE
ROCHESTER NY
14621-3011
US

IV. Provider business mailing address

116 LEAH CRES
THORNHILL ONTARIO
L4J 8C3
UG

V. Phone/Fax

Practice location:
  • Phone: 585-922-5067
  • Fax: 585-922-2908
Mailing address:
  • Phone: 862-237-0726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number303687
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: