Provider Demographics
NPI:1770659005
Name:LUCIA RICCI, JODIE ITALIA (MD)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:ITALIA
Last Name:LUCIA RICCI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 MORRIS AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1225
Mailing Address - Country:US
Mailing Address - Phone:973-232-6900
Mailing Address - Fax:973-232-6912
Practice Address - Street 1:155 MORRIS AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1225
Practice Address - Country:US
Practice Address - Phone:973-232-6900
Practice Address - Fax:973-232-6912
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063146207W00000X
NJ25MA09550000207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00242171OtherRAILROAD
P00242171OtherRAILROAD
G0202P02Medicare ID - Type Unspecified