Healthcare Provider Details

I. General information

NPI: 1437866563
Provider Name (Legal Business Name): PHILIP RICCIARDI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 MARIETTA AVE
HAWTHORNE NY
10532-1910
US

IV. Provider business mailing address

286 MARIETTA AVE
HAWTHORNE NY
10532-1910
US

V. Phone/Fax

Practice location:
  • Phone: 914-330-2904
  • Fax:
Mailing address:
  • Phone: 914-330-2904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number117906-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: