Provider Demographics
NPI:1285680850
Name:RICKETTI, ANTHONY J (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:J
Last Name:RICKETTI
Suffix:
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 1:1544 KUSER RD STE C6
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3830
Mailing Address - Country:US
Mailing Address - Phone:609-581-9900
Mailing Address - Fax:609-581-9905
Practice Address - Street 1:1544 KUSER RD
Practice Address - Street 2:SUITE C-6
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3830
Practice Address - Country:US
Practice Address - Phone:609-581-9900
Practice Address - Fax:609-581-9905
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04369400207K00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1213709Medicaid
NJ1213709Medicaid
NJ1213709Medicaid