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General NPI Number Information
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NPI Number | 1447311774
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Entity Type | Individual
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Provider Name | ANTHONY RICCARDELLA ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 84 STATE ROUTE 31
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City | FLEMINGTON
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State | NJ
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Zip | 08822-1251
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Country | US
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Telephone | 908-284-7214
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Fax |
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Provider Business Mailing Address
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Address Line | 114 RIVER ST
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City | MONROE TWP
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State | NJ
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Zip | 08831-2464
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Country | US
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Telephone | 732-416-0113
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 25MT00070600
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License Number State | NJ
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