MEDICARE: RICARDO LITTLE

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
1	163W00000X	Registered Nurse	554254	NY

General Provider Information

NPI Number	:	1184260648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICARDO LITTLE

Provider Business Mailing Address
First Line	:	4200 WHITE PLAINS ROAD, SUITE 101
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 WHITE PLAINS RD STE 101
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-3014
Country	:	US
Telephone Number	:	347-819-3330
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2019
Last Update Date	:	11/20/2019

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Directions to “ RICARDO LITTLE ” Practice Location

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