Provider Demographics
NPI:1013283233
Name:RICKETTI, PETER ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ANTHONY
Last Name:RICKETTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 KUSER RD STE C6
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3830
Mailing Address - Country:US
Mailing Address - Phone:609-581-9900
Mailing Address - Fax:609-581-9905
Practice Address - Street 1:1544 KUSER RD STE C6
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3830
Practice Address - Country:US
Practice Address - Phone:609-581-9900
Practice Address - Fax:609-581-9905
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13538207RA0201X, 207RS0012X
NJ25MB10285900207RS0012X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine