Provider Demographics
NPI:1417927682
Name:RICCELLI, JAMES P (PT, ECS, CERT MDT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:RICCELLI
Suffix:
Gender:M
Credentials:PT, ECS, CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4939 BRITTONFIELD PARKWAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:E. SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057
Mailing Address - Country:US
Mailing Address - Phone:315-234-7322
Mailing Address - Fax:315-634-3264
Practice Address - Street 1:4939 BRITTONFIELD PKWY
Practice Address - Street 2:
Practice Address - City:E SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9208
Practice Address - Country:US
Practice Address - Phone:315-234-7322
Practice Address - Fax:315-634-3264
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009034-12251E1300X
NY0090341174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA6149Medicare PIN
NYDD5415Medicare PIN