Healthcare Provider Details

I. General information

NPI: 1205310802
Provider Name (Legal Business Name): ANDREA FICARRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 MAIN ST
PATERSON NJ
07503-2621
US

IV. Provider business mailing address

15 BERKELEY SQ
BERKELEY HEIGHTS NJ
07922-2472
US

V. Phone/Fax

Practice location:
  • Phone: 973-754-4230
  • Fax:
Mailing address:
  • Phone: 973-229-9688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1089811
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: