Healthcare Provider Details

I. General information

NPI: 1306754049
Provider Name (Legal Business Name): FIZA RAZA RIZVI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CLOVE RD APT GC
STATEN ISLAND NY
10301-3632
US

IV. Provider business mailing address

1100 CLOVE RD APT GC
STATEN ISLAND NY
10301-3632
US

V. Phone/Fax

Practice location:
  • Phone: 718-816-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number056403
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: