Provider Demographics
NPI:1952403974
Name:RICKETTI, JAMES C (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
Last Name:RICKETTI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2273 RT 33
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HAMILTON SQ
Mailing Address - State:NJ
Mailing Address - Zip Code:08690
Mailing Address - Country:US
Mailing Address - Phone:609-587-1674
Mailing Address - Fax:609-587-2206
Practice Address - Street 1:2273 STATE HWY 33 SUITE 204
Practice Address - Street 2:2273 STATE HWY 33 AUITE 204
Practice Address - City:HAMILTON SQ
Practice Address - State:NJ
Practice Address - Zip Code:08690
Practice Address - Country:US
Practice Address - Phone:609-587-1674
Practice Address - Fax:609-587-2206
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01287213E00000X, 213ES0000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T44950Medicare UPIN
438618Medicare ID - Type Unspecified