Provider Demographics
NPI:1073983979
Name:RICKS, PATAWE (MED)
Entity Type:Individual
Prefix:
First Name:PATAWE
Middle Name:
Last Name:RICKS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:PATAWE
Other - Middle Name:
Other - Last Name:SIMMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:968 SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903-2427
Mailing Address - Country:US
Mailing Address - Phone:631-438-6962
Mailing Address - Fax:
Practice Address - Street 1:1311 MAMARONECK AVE STE 150
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-5222
Practice Address - Country:US
Practice Address - Phone:914-328-2868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist