Provider Demographics
NPI:1407138464
Name:SKORDOS, RITSA
Entity Type:Individual
Prefix:MS
First Name:RITSA
Middle Name:
Last Name:SKORDOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 PREAKNESS AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07502-1757
Mailing Address - Country:US
Mailing Address - Phone:973-575-1075
Mailing Address - Fax:973-575-5321
Practice Address - Street 1:350 PREAKNESS AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07502-1757
Practice Address - Country:US
Practice Address - Phone:973-575-1075
Practice Address - Fax:973-575-5321
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02346700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist