Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | QA9717 | NJ |
NPI | 1023071982 |
---|---|
Provider Name | Dr. Marc Francis Riccardi |
First Address | Basking Ridge, NJ 07920-1686 |
Second Address | Basking Ridge, NJ 07920-1686 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 15/08/2012 |