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General NPI Number Information
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NPI Number | 1689739468
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Entity Type | Individual
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Provider Name | CHARLES ANTHONY RICCIARDELLI MD
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Gender | Male
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 19 BRADHURST AVE STE 1800
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City | HAWTHORNE
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State | NY
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Zip | 10532-2140
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Country | US
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Telephone | 914-347-5822
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Fax |
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Provider Business Mailing Address
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Address Line | 19 BRADHURST AVE STE 1800
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City | HAWTHORNE
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State | NY
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Zip | 10532-2140
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Country | US
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Telephone | 914-347-5822
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 113743
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License Number State | NY
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