Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 258850 | NY |
Y | 2084N0400X | Neurologist | 25MA09073400 | NJ |
NPI | 1023218096 |
---|---|
Provider Name | Rikki Redona Racela |
First Address | Englewood, NJ 07631-4957 |
Second Address | Englewood, NJ 07631-4957 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2007 |
Last Update Date | 16/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
258850 | NY STATE EDUCATION DEPT. OFFICE OF THE PROFESSIONS (01) | NY |
25MA09073400 | NJ BOARD OF MEDICAL EXAMINERS (01) | NJ |