Provider Demographics
NPI:1154687267
Name:RICCI, DAVID (OT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:RICCI
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 LEXINGTON AVE
Mailing Address - Street 2:SUITE 233
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10170-0002
Mailing Address - Country:US
Mailing Address - Phone:212-697-3438
Mailing Address - Fax:212-697-5983
Practice Address - Street 1:420 LEXINGTON AVE
Practice Address - Street 2:SUITE 233
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10170-0002
Practice Address - Country:US
Practice Address - Phone:212-697-3438
Practice Address - Fax:212-697-5983
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005214225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQS8411Medicare UPIN