Provider Demographics
NPI:1053372722
Name:RIZKALLA, ANNE-MARIE (CNM)
Entity type:Individual
Prefix:
First Name:ANNE-MARIE
Middle Name:
Last Name:RIZKALLA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MOUNTAIN BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5605
Mailing Address - Country:US
Mailing Address - Phone:908-561-1102
Mailing Address - Fax:908-561-1106
Practice Address - Street 1:27 MOUNTAIN BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5605
Practice Address - Country:US
Practice Address - Phone:908-561-1102
Practice Address - Fax:908-561-1106
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00035701367A00000X, 176B00000X
NYF000925-1176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1666401Medicaid