Provider Demographics
NPI:1023218096
Name:RACELA, RIKKI REDONA (MD)
Entity Type:Individual
Prefix:
First Name:RIKKI
Middle Name:REDONA
Last Name:RACELA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ROCKWOOD PL
Mailing Address - Street 2:#110
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4957
Mailing Address - Country:US
Mailing Address - Phone:201-894-5805
Mailing Address - Fax:
Practice Address - Street 1:25 ROCKWOOD PL
Practice Address - Street 2:#110
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4957
Practice Address - Country:US
Practice Address - Phone:201-894-5805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA090734002084N0400X
NY2588502084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA09073400OtherNJ BOARD OF MEDICAL EXAMINERS
NY258850OtherNY STATE EDUCATION DEPT. OFFICE OF THE PROFESSIONS