Healthcare Provider Details

I. General information

NPI: 1578682340
Provider Name (Legal Business Name): DENISE ELIZABETH RICCOBONO PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 COMMUNITY DR DIVISION OF INFECTIOUS DISEASES
MANHASSET NY
11030-3815
US

IV. Provider business mailing address

400 COMMUNITY DR DIVISION OF INFECTIOUS DISEASES
MANHASSET NY
11030-3815
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-3368
  • Fax:
Mailing address:
  • Phone: 516-562-3368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number050639
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: