Provider Demographics
NPI:1023071982
Name:RICCARDI, MARC FRANCIS (DPT)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:FRANCIS
Last Name:RICCARDI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N FINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-1686
Mailing Address - Country:US
Mailing Address - Phone:908-340-4772
Mailing Address - Fax:908-340-4774
Practice Address - Street 1:150 N FINLEY AVE
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-1686
Practice Address - Country:US
Practice Address - Phone:908-340-4772
Practice Address - Fax:908-340-4774
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA97172251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ056681Medicare ID - Type UnspecifiedMEDICARE ID NUMBER