Healthcare Provider Details

I. General information

NPI: 1982825980
Provider Name (Legal Business Name): RIKKI TIMMONS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BERGEN ST UH, ROOM B-403
NEWARK NJ
07103-2496
US

IV. Provider business mailing address

54 PARK AVE #19
VERONA NJ
07044-2450
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-2804
  • Fax:
Mailing address:
  • Phone: 973-303-8364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: