Healthcare Provider Details

I. General information

NPI: 1255574844
Provider Name (Legal Business Name): BENJAMIN FOX RICCIARDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2009
Last Update Date: 06/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SOUTH AVE
ROCHESTER NY
14620-2733
US

IV. Provider business mailing address

1000 SOUTH AVE
ROCHESTER NY
14620-2733
US

V. Phone/Fax

Practice location:
  • Phone: 201-669-8216
  • Fax:
Mailing address:
  • Phone: 201-669-8216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number260357
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number260357
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: