Provider Demographics
NPI:1801258066
Name:RICCIO, NICHOLAS VINCENT (DC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:VINCENT
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 1:301 E 76TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2403
Mailing Address - Country:US
Mailing Address - Phone:386-299-1545
Mailing Address - Fax:212-759-8046
Practice Address - Street 1:235 E 49TH ST PH C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1558
Practice Address - Country:US
Practice Address - Phone:212-688-2900
Practice Address - Fax:212-759-8046
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012728111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor