Provider Demographics
NPI:1619354669
Name:RICCIARDONE, GAETANO A (DC)
Entity Type:Individual
Prefix:
First Name:GAETANO
Middle Name:A
Last Name:RICCIARDONE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 JULIETTE DR
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3914
Mailing Address - Country:US
Mailing Address - Phone:551-998-9779
Mailing Address - Fax:
Practice Address - Street 1:1503 JULIETTE DR
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-3914
Practice Address - Country:US
Practice Address - Phone:551-998-9779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00503000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor