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General NPI Number Information
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NPI Number | 1457536864
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Entity Type | Individual
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Provider Name | JOHN RICCIARDI M. A., CCC-SLP
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Gender | Male
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 11/11/2009
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Provider Practice Location Address
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Address Line | 390 AMWELL RD SUITE 104
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-1225
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Country | US
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Telephone | 732-873-7600
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Fax | 732-873-7676
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Provider Business Mailing Address
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Address Line | 390 AMWELL RD SUITE 104
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-1225
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Country | US
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Telephone | 732-873-7600
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Fax | 732-873-7676
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 41YS00069400
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License Number State | NJ
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