MEDICARE: DR. HAIG HERBERT DANIEL RICKERBY D.M.D.

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	1223G0001X	General Practice Dentistry	16164	NJ

General Provider Information

NPI Number	:	1407848708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAIG HERBERT DANIEL RICKERBY D.M.D.

Provider Business Mailing Address
First Line	:	1 JOURNAL SQUARE PLZ
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-4004
Country	:	US
Telephone Number	:	201-656-2221
Fax Number	:	201-656-6308

Provider Business Practice Location Address
First Line	:	1 JOURNAL SQUARE PLZ
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-4004
Country	:	US
Telephone Number	:	201-656-2221
Fax Number	:	201-656-6308

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	07/08/2007

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