Provider Demographics
NPI:1285677641
Name:RICCA, JEANINE MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:JEANINE
Middle Name:MARIE
Last Name:RICCA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JEANINE
Other - Middle Name:MARIE
Other - Last Name:RICCA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:382 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2739
Mailing Address - Country:US
Mailing Address - Phone:845-721-5987
Mailing Address - Fax:
Practice Address - Street 1:1980 CROMPOND RD
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-4144
Practice Address - Country:US
Practice Address - Phone:914-788-4635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH21493207V00000X
NMDO2022-0082207V00000X
KYC0705207V00000X
HIDOS-2252207V00000X
MEDO3224207V00000X
MELT20095207V00000X
MTMED-PHYS-COM-LIC-992207V00000X
NY276046-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02960350Medicaid
NYA400017859Medicare PIN
S98773Medicare UPIN