Provider Demographics
NPI:1164485314
Name:RICCIARDI, ANTHONY MICHAEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:MICHAEL
Last Name:RICCIARDI
Suffix:JR
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 1:172 HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2663
Mailing Address - Country:US
Mailing Address - Phone:973-678-3133
Mailing Address - Fax:973-678-6305
Practice Address - Street 1:172 HALSTED ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2663
Practice Address - Country:US
Practice Address - Phone:973-678-3133
Practice Address - Fax:973-678-6305
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF43726Medicare UPIN
NJ527271Medicare ID - Type UnspecifiedMEDICARE