Provider Demographics
NPI:1114124161
Name:CHOICE SPINE JOINT & NEUROLOGY,PC
Entity Type:Organization
Organization Name:CHOICE SPINE JOINT & NEUROLOGY,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICCIARDELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-744-4777
Mailing Address - Street 1:799 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8564
Mailing Address - Country:US
Mailing Address - Phone:631-744-4777
Mailing Address - Fax:631-744-3220
Practice Address - Street 1:799 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8564
Practice Address - Country:US
Practice Address - Phone:631-744-4777
Practice Address - Fax:631-744-3220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWU4681Medicare PIN
NYC09456Medicare UPIN