Provider Demographics
NPI:1538318654
Name:TRICARICO, JAMES FRANK (R-PAC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:FRANK
Last Name:TRICARICO
Suffix:
Gender:M
Credentials:R-PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8603 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4221
Mailing Address - Country:US
Mailing Address - Phone:718-680-9313
Mailing Address - Fax:718-680-1841
Practice Address - Street 1:2 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4210
Practice Address - Country:US
Practice Address - Phone:718-680-8300
Practice Address - Fax:718-680-1841
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004680-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical