Provider Demographics
NPI:1215057930
Name:PASCETTA, RICCARDO
Entity type:Individual
Prefix:
First Name:RICCARDO
Middle Name:
Last Name:PASCETTA
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 1:751 TEANECK RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4242
Mailing Address - Country:US
Mailing Address - Phone:201-837-5599
Mailing Address - Fax:201-833-9238
Practice Address - Street 1:751 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4242
Practice Address - Country:US
Practice Address - Phone:201-837-5599
Practice Address - Fax:201-833-9238
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTDO1673332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0629890001Medicare ID - Type Unspecified