Individual
DR. RICHARD F IANNACONE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
VALLEY HOSPITAL, 233 VAN DIEN AVE, RIDGEWOOD, NJ 07450
(201) 447-8000
Mailing address
500 W MAIN ST, SUITE 16, WYCKOFF, NJ 07481-1439
(201) 847-9403
(201) 847-0059
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
25MB05568500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6067204
—
NJ
Enumeration date
03/23/2006
Last updated
07/08/2007
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