Individual
CHARLES ANTHONY RICCOBONO
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20 PROSPECT AVE, SUITE 915, HACKENSACK, NJ 07601
(201) 342-9119
(201) 342-3735
Mailing address
20 PROSPECT AVE, SUITE 915, HACKENSACK, NJ 07601
(201) 342-9119
(201) 342-3735
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MA24007
NJ
207RG0100X
Gastroenterology Physician
Primary
MA24007
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1415301
—
NJ
Enumeration date
02/08/2006
Last updated
09/11/2025
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