Provider Demographics
NPI:1285816074
Name:RIFICI, SALVATORE MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:SALVATORE
Middle Name:MICHAEL
Last Name:RIFICI
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 1:480 KEARNY AVENUE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-2736
Mailing Address - Country:US
Mailing Address - Phone:201-997-4000
Mailing Address - Fax:201-997-3345
Practice Address - Street 1:416 KEARNY AVENUE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2604
Practice Address - Country:US
Practice Address - Phone:201-997-4000
Practice Address - Fax:201-997-3345
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA055458207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F06983Medicare UPIN