Provider Demographics
NPI:1124662051
Name:RICIGLIANO, LISA MARIE (PTA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:RICIGLIANO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 W HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1609
Mailing Address - Country:US
Mailing Address - Phone:201-638-3417
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:155 W HUDSON AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1609
Practice Address - Country:US
Practice Address - Phone:201-638-3417
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00139500225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant