Provider Demographics
NPI:1285930693
Name:RICCI, TAMI
Entity type:Individual
Prefix:MRS
First Name:TAMI
Middle Name:
Last Name:RICCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 W 125TH ST FL 12
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4436
Mailing Address - Country:US
Mailing Address - Phone:212-961-8723
Mailing Address - Fax:212-866-2760
Practice Address - Street 1:163 W 125TH ST FL 12
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4436
Practice Address - Country:US
Practice Address - Phone:212-961-8723
Practice Address - Fax:212-866-2760
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY461478-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY163W00000XMedicaid