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General NPI Number Information
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NPI Number | 1265545313
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Entity Type | Individual
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Provider Name | LISA L. RICCIO DPM
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Gender | Female
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 07/09/2008
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Provider Practice Location Address
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Address Line | 325 PARK AVE
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City | HUNTINGTON
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State | NY
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Zip | 11743-2779
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Country | US
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Telephone | 631-351-3722
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Fax | 631-385-1046
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Provider Business Mailing Address
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Address Line | 325 PARK AVE
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City | HUNTINGTON
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State | NY
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Zip | 11743-2779
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Country | US
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Telephone | 631-351-3722
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Fax | 631-385-1046
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | N005238-1
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License Number State | NY
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