Provider Demographics
NPI:1376599142
Name:RICOTTA, JOHN J (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:RICOTTA
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 1:9960 CENTRAL PARK BLVD N STE 150A
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1760
Mailing Address - Country:US
Mailing Address - Phone:561-303-0013
Mailing Address - Fax:561-499-3199
Practice Address - Street 1:9960 CENTRAL PARK BLVD N STE 150A
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1760
Practice Address - Country:US
Practice Address - Phone:561-303-0013
Practice Address - Fax:561-499-3199
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1422062086S0129X
FLME1528502086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00484377Medicaid
FL112444200Medicaid
NY5914009OtherAETNA
NY67E541OtherEMPIRE B/C B/S
NYC49468Medicare UPIN