Provider Demographics
NPI:1609000322
Name:RICCOBONO, JOSEPH M (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:M
Last Name:RICCOBONO
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-2403
Mailing Address - Country:US
Mailing Address - Phone:201-788-7785
Mailing Address - Fax:
Practice Address - Street 1:25 CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-2403
Practice Address - Country:US
Practice Address - Phone:201-788-7785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015613225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics