Provider Demographics
NPI:1851418446
Name:RICCIO, MARTIN L (DC)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:L
Last Name:RICCIO
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 1:801 HUGHES DR
Mailing Address - Street 2:
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-1207
Mailing Address - Country:US
Mailing Address - Phone:609-584-1313
Mailing Address - Fax:
Practice Address - Street 1:801 HUGHES DR
Practice Address - Street 2:
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08690-1207
Practice Address - Country:US
Practice Address - Phone:609-584-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00230700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ618467Medicare PIN