Individual
RENA MARIE RICCARDI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD, CDE
Contact information
Practice address
255 LAFAYETTE AVE, SUFFERN, NY 10901-4869
(914) 772-1005
(845) 547-3357
Mailing address
4 JUNIPER DR, LAKE LINCOLNDALE, NY 10541-5300
(914) 772-1005
(914) 556-6356
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
724462
—
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
724462
—
174H00000X
Health Educator
—
—
2080B0002X
Pediatric Obesity Medicine Physician
724462
NY
2080P0205X
Pediatric Endocrinology Physician
217003387
NY
311ZA0620X
Adult Care Home Facility
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21700387
NCBDE
—
01
—
724462
CDR
—
Enumeration date
07/17/2018
Last updated
07/17/2018
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