Provider Demographics
NPI:1285882365
Name:JEROME, RICARDEL
Entity type:Individual
Prefix:
First Name:RICARDEL
Middle Name:
Last Name:JEROME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 W 162ND ST APT 47
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-4522
Mailing Address - Country:US
Mailing Address - Phone:718-398-0153
Mailing Address - Fax:718-623-2531
Practice Address - Street 1:64 E MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2931
Practice Address - Country:US
Practice Address - Phone:201-498-9144
Practice Address - Fax:201-498-9144
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator