Provider Demographics
NPI:1821714783
Name:JAMISON, RICKY RICARDO JR
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:RICARDO
Last Name:JAMISON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:KEANSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07734-1651
Mailing Address - Country:US
Mailing Address - Phone:551-247-5816
Mailing Address - Fax:
Practice Address - Street 1:41 SHORE BLVD
Practice Address - Street 2:
Practice Address - City:KEANSBURG
Practice Address - State:NJ
Practice Address - Zip Code:07734-1651
Practice Address - Country:US
Practice Address - Phone:551-247-5816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program