Healthcare Provider Details

I. General information

NPI: 1073631081
Provider Name (Legal Business Name): DIANA RICCIOLI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 CLIFTON AVE STE 103
CLIFTON NJ
07013-2724
US

IV. Provider business mailing address

230 E RIDGEWOOD AVE
PARAMUS NJ
07652-4142
US

V. Phone/Fax

Practice location:
  • Phone: 973-417-5256
  • Fax: 973-471-5157
Mailing address:
  • Phone: 201-967-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberMA61908
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA06190800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: