Provider Demographics
NPI:1356980403
Name:RICARTE, JOHANNE PAYLADO
Entity type:Individual
Prefix:
First Name:JOHANNE
Middle Name:PAYLADO
Last Name:RICARTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOHANNE
Other - Middle Name:ZARTIGA
Other - Last Name:PAYLADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4735 196TH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3934
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3227 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5707
Practice Address - Country:US
Practice Address - Phone:718-904-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0413072081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine