Provider Demographics
NPI:1932227402
Name:RALPH E RICCIARDI JR MD PA
Entity Type:Organization
Organization Name:RALPH E RICCIARDI JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:RICCIARDI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:201-861-9422
Mailing Address - Street 1:7312 BERGENLINE AVENUE
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047
Mailing Address - Country:US
Mailing Address - Phone:201-861-9422
Mailing Address - Fax:201-295-2932
Practice Address - Street 1:7312 BERGENLINE AVENUE
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047
Practice Address - Country:US
Practice Address - Phone:201-861-9422
Practice Address - Fax:201-295-2932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03139600207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ475622Medicare ID - Type Unspecified
D06400Medicare UPIN