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General NPI Number Information
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NPI Number | 1669456893
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Entity Type | Individual
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Provider Name | ELLEN PATRICIA NOLAN RICCOBENE
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Gender | Female
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Dates
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Enumeration Date | 12/01/2005
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Last Update Date | 08/16/2007
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Provider Practice Location Address
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Address Line | 9331 OLD BUSTLETON AVE STE 201
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City | PHILADELPHIA
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State | PA
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Zip | 19115
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Country | US
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Telephone | 215-602-8500
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Fax | 215-676-6507
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Provider Business Mailing Address
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Address Line | 2450 W HUNTING PARK AVE 2ND TPI
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City | PHILADELPHIA
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State | PA
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Zip | 19129-1302
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Country | US
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Telephone | 215-926-9019
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Fax | 215-226-8286
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | M2419567
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License Number State | PA
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