Provider Demographics
NPI:1447311774
Name:RICCARDELLA, ANTHONY (ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:RICCARDELLA
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:MONROE TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-2464
Mailing Address - Country:US
Mailing Address - Phone:732-416-0113
Mailing Address - Fax:
Practice Address - Street 1:84 STATE ROUTE 31
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-1251
Practice Address - Country:US
Practice Address - Phone:908-284-7214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000706002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer