Provider Demographics
NPI:1396993937
Name:DR. JAMES C. RICKETTI
Entity type:Organization
Organization Name:DR. JAMES C. RICKETTI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:RICKETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:609-587-1674
Mailing Address - Street 1:2273 STATE HIGHWAY 33 STE 204
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-1747
Mailing Address - Country:US
Mailing Address - Phone:609-587-1674
Mailing Address - Fax:609-587-2206
Practice Address - Street 1:2273 STATE HIGHWAY 33 STE 204
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-1747
Practice Address - Country:US
Practice Address - Phone:609-587-1674
Practice Address - Fax:609-587-2206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00128700213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0900280001Medicare NSC