Basic Information
| Provider Information | |||||||||
| NPI: | 1609937705 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICCA | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 510 HICKSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | MASSAPEQUA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117581203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167952626 | ||||||||
| FaxNumber: | 5167997451 | ||||||||
| Practice Location | |||||||||
| Address1: | 510 HICKSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | MASSAPEQUA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117581203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167952626 | ||||||||
| FaxNumber: | 5167997451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 08/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 199218 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 067SP1 | 01 | BLUE CROSS BLUE SHIELD | OTHER | 201285536 | 01 | UHC | OTHER | 201285536 | 01 | SELECT PRFO | OTHER | 199218 | 01 | HIP | OTHER | 2012855356 | 01 | HORIZON | OTHER | 201285536 | 01 | MULTI | OTHER | 3732093 | 01 | CIGNA | OTHER | 201285536 | 01 | EMPIRE | OTHER | 201285536 | 01 | MAGNACARE | OTHER | 2590592 | 01 | GHI | OTHER | P451722 | 01 | OXFORD | OTHER | 2121466 | 01 | VYTRA | OTHER | 5749201 | 01 | AETNA | OTHER | P00221182 | 01 | RR MCR | OTHER | 201285536 | 01 | LOCAL 1199 | OTHER | 4C8693 | 01 | HEALTHNET | OTHER |