Provider Demographics
NPI:1518955715
Name:RICCI, ALEXANDER J (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:J
Last Name:RICCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6134 188TH ST
Mailing Address - Street 2:STE 218
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2726
Mailing Address - Country:US
Mailing Address - Phone:718-454-9700
Mailing Address - Fax:718-454-6060
Practice Address - Street 1:6134 188TH ST
Practice Address - Street 2:STE 218
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2726
Practice Address - Country:US
Practice Address - Phone:718-454-9700
Practice Address - Fax:718-454-6060
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY151246-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00971100Medicaid
NY59452Medicare ID - Type Unspecified
A63635Medicare UPIN