Provider Demographics
NPI:1699762658
Name:RITOTA, PERRY CHARLES (MD)
Entity type:Individual
Prefix:
First Name:PERRY
Middle Name:CHARLES
Last Name:RITOTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PROSPECT AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1997
Mailing Address - Country:US
Mailing Address - Phone:201-342-7333
Mailing Address - Fax:201-342-4490
Practice Address - Street 1:20 PROSPECT AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1997
Practice Address - Country:US
Practice Address - Phone:201-342-7333
Practice Address - Fax:201-342-4490
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA565942086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ729618Medicare ID - Type Unspecified
G22760Medicare UPIN