Basic Information
| Provider Information | |||||||||
| NPI: | 1073631081 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICCIOLI | ||||||||
| FirstName: | DIANA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 230 E RIDGEWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | PARAMUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076524142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019674000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 925 CLIFTON AVE | ||||||||
| Address2: | STE 103 | ||||||||
| City: | CLIFTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070132724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734175256 | ||||||||
| FaxNumber: | 9734715157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 06/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084B0040X | MA61908 | NJ | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry | 2084P0800X | 25MA06190800 | NJ | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.