Healthcare Provider Details

I. General information

NPI: 1023218096
Provider Name (Legal Business Name): RIKKI REDONA RACELA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ROCKWOOD PL #110
ENGLEWOOD NJ
07631-4957
US

IV. Provider business mailing address

25 ROCKWOOD PL #110
ENGLEWOOD NJ
07631-4957
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-5805
  • Fax:
Mailing address:
  • Phone: 201-894-5805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA09073400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number258850
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: