Individual provider Active NPI

Jamil F Rizqalla, DO

  • Emergency Medical Services (Emergency Medicine) Physician
  • Livingston, NJ
National Provider Identifier
1285778258
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
245032 Issued in NY
Practice address
651 West Mount Pleasant Ave
Livingston, NJ 07039
Phone
(973) 740-0607
Fax
(973) 740-9895
NPI assigned
Feb 16, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 5101015686 MI
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 245032 NY Primary

Addresses

Primary practice location

651 West Mount Pleasant Ave
Livingston, NJ 07039

Mailing address

651 W Mount Pleasant Ave
Livingston, NJ 07039-1600
Phone (973) 740-0607

Other identifiers 1

IdentifierTypeStateIssuer
245032OtherNYNEW YORK STATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070926000008 NY Practitioner - Emergency Medicine 1355435090 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
5101015686MIMDEmergency Medicine Physician
245032NYMDEmergency Medical Services (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Westchester Hospital Association Emergency Medicine CurrentSince Dec 1, 2013 Accepting new patients
Montefiore Nyack Hospital CurrentSince Jan 1, 2014 Accepting new patients
Northern Westchester Hospital Association CurrentSince Dec 1, 2013 Accepting new patients
Northern Westchester Hospital Association Current Accepting new patients
Montefiore Nyack Hospital CurrentSince Jan 1, 2014 Accepting new patients
Nyack Emergency Medical Association PLLC Emergency Medicine CurrentSince Jul 1, 2007 Accepting new patients

Locations

400 E Main St
Mount Kisco, NY 10549
Phone (914) 666-1200

400 E Main St
Fl 4
Mount Kisco, NY 10549
Phone (914) 242-8318

160 N Midland Ave
Nyack, NY 10960
Phone (845) 348-2000

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1285778258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "651 W MOUNT PLEASANT AVE",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070391600",
            "telephone_number": "973-740-0607",
            "fax_number": "973-740-9895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 WEST MOUNT PLEASANT AVE",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "07039",
            "telephone_number": "973-740-0607",
            "fax_number": "973-740-9895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIZQALLA",
        "first_name": "JAMIL",
        "middle_name": "F",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-16",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5101015686",
            "primary": false
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "NY",
            "license": "245032",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW YORK STATE LICENSE",
            "identifier": "245032",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Livingston, NJ

Sources for this page

Verify at the official NPI Registry.