Provider Demographics
NPI:1346446812
Name:MARIO Q.RICCI M.D., P.C.
Entity Type:Organization
Organization Name:MARIO Q.RICCI M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:Q
Authorized Official - Last Name:RICCI
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:914-963-4936
Mailing Address - Street 1:1254 CENTRAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-1059
Mailing Address - Country:US
Mailing Address - Phone:914-963-4936
Mailing Address - Fax:914-964-8336
Practice Address - Street 1:1254 CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-1059
Practice Address - Country:US
Practice Address - Phone:914-963-4936
Practice Address - Fax:914-964-8336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076517207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC09343Medicare UPIN