Provider Demographics
NPI:1679849731
Name:JOSEPH J. RIDILLA,D.O.PC
Entity Type:Organization
Organization Name:JOSEPH J. RIDILLA,D.O.PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:RIDILLA
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:570-825-4460
Mailing Address - Street 1:476 E NORTHAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6329
Mailing Address - Country:US
Mailing Address - Phone:570-825-4460
Mailing Address - Fax:570-825-6140
Practice Address - Street 1:476 E NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6329
Practice Address - Country:US
Practice Address - Phone:570-825-4460
Practice Address - Fax:570-825-6140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007440L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty