Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 25MB10285900 | NJ |
N | 207RA0201X | Internist - Allergy & Immunology | OS13538 | FL |
N | 207RS0012X | Sleep Medicine | 25MB10285900 | NJ |
N | 207RS0012X | Sleep Medicine | OS13538 | FL |
NPI | 1013283233 |
---|---|
Provider Name | Dr. Peter Anthony Ricketti |
First Address | Kansas City, MO 64187-4436 |
Second Address | Trenton, NJ 08619-3830 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2012 |
Last Update Date | 05/10/2021 |