Healthcare Provider Details

I. General information

NPI: 1851374839
Provider Name (Legal Business Name): DANIEL DOUGLAS RICCIARDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 PIERREPONT ST
BROOKLYN NY
11201-2427
US

IV. Provider business mailing address

85 PIERREPONT ST
BROOKLYN NY
11201-2427
US

V. Phone/Fax

Practice location:
  • Phone: 718-834-0700
  • Fax:
Mailing address:
  • Phone: 718-834-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number156247
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: