Provider Demographics
NPI:1548446123
Name:PETER J RIZNYK DPM PLLC
Entity type:Organization
Organization Name:PETER J RIZNYK DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIZNYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-662-7729
Mailing Address - Street 1:6272 W QUAKER ST
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2644
Mailing Address - Country:US
Mailing Address - Phone:716-662-7729
Mailing Address - Fax:716-662-1822
Practice Address - Street 1:6272 W QUAKER ST
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2644
Practice Address - Country:US
Practice Address - Phone:716-662-7729
Practice Address - Fax:716-662-1822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004194332B00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01012468Medicaid
NY0827460001Medicare NSC
NY01012468Medicaid
NY045461Medicare PIN