Provider Demographics
NPI:1609937705
Name:RICCA, PAUL (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:RICCA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 HICKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1203
Mailing Address - Country:US
Mailing Address - Phone:516-795-2626
Mailing Address - Fax:516-799-7451
Practice Address - Street 1:510 HICKSVILLE RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1203
Practice Address - Country:US
Practice Address - Phone:516-795-2626
Practice Address - Fax:516-799-7451
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199218207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
067SP1OtherBLUE CROSS BLUE SHIELD
201285536OtherUHC
201285536OtherSELECT PRFO
199218OtherHIP
2012855356OtherHORIZON
201285536OtherMULTI
3732093OtherCIGNA
201285536OtherEMPIRE
201285536OtherMAGNACARE
2590592OtherGHI
P451722OtherOXFORD
2121466OtherVYTRA
5749201OtherAETNA
P00221182OtherRR MCR
201285536OtherLOCAL 1199
4C8693OtherHEALTHNET
201285536OtherSELECT PRFO
2121466OtherVYTRA