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NPI Code Detail

MEDICARE: PATAWE RICKS M.ED.

MEDICARE:   PATAWE  RICKS  M.ED.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

General Provider Information

NPI Number : 1073983979
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATAWE RICKS M.ED.
Provider Business Mailing Address
First Line : 968 SUNSET RD
Second Line :
City : STAMFORD
State : CT
Zip : 06903-2427
Country : US
Telephone Number : 631-438-6962
Fax Number :
Provider Business Practice Location Address
First Line : 1311 MAMARONECK AVE STE 150
Second Line :
City : WHITE PLAINS
State : NY
Zip : 10605-5222
Country : US
Telephone Number : 914-328-2868
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2015
Last Update Date : 09/20/2022

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Directions to “ PATAWE RICKS M.ED.” Practice Location

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