Provider Demographics
NPI:1669634333
Name:RICCI, PERRY ROGERS (DC)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:ROGERS
Last Name:RICCI
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 1:43 YAWPO AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-2714
Mailing Address - Country:US
Mailing Address - Phone:201-481-1537
Mailing Address - Fax:201-227-0986
Practice Address - Street 1:43 YAWPO AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-2714
Practice Address - Country:US
Practice Address - Phone:201-481-1537
Practice Address - Fax:201-227-0986
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00191300111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ085667Medicare PIN