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General NPI Number Information
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NPI Number | 1538361878
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Entity Type | Organization
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Legal Business Name | HAZLET HEALTH CARE
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 09/23/2010
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Provider Practice Location Address
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Address Line | 3253 STATE ROUTE 35 SUITE 1
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City | HAZLET
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State | NJ
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Zip | 07730-1544
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Country | US
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Telephone | 732-264-5656
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Fax | 732-264-8625
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Provider Business Mailing Address
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Address Line | 3253 STATE ROUTE 35 SUITE 1
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City | HAZLET
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State | NJ
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Zip | 07730-1544
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Country | US
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Telephone | 732-264-5656
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Fax | 732-264-8625
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANTHONY JOSEPH RICCA
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Credential | M.D.
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Telephone | 732-264-5656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 25MA05277600
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License Number State | NJ
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