Provider Demographics
NPI:1417049131
Name:REY, RICARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
Last Name:REY
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 1:960 PAULISON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-3607
Mailing Address - Country:US
Mailing Address - Phone:973-773-7713
Mailing Address - Fax:973-773-7723
Practice Address - Street 1:960 PAULISON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-3607
Practice Address - Country:US
Practice Address - Phone:973-773-7713
Practice Address - Fax:973-773-7723
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08429300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY330AX1Medicaid
NY243044OtherLICENSE
NY02687474Medicare ID - Type Unspecified