NPIMap

Individual provider Active NPI

Mark A Ricigliano, D.O.

  • Family Medicine Physician
  • Pennsauken, NJ
National Provider Identifier
1366482630
Registry record updated May 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MB048807 Issued in NJ
Practice address
6705 Park Ave
Pennsauken, NJ 08109
Phone
(856) 662-0017
Fax
(856) 662-6016
NPI assigned
Jun 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MB048807 NJ Primary

Addresses

Primary practice location

6705 Park Ave
Pennsauken, NJ 08109

Mailing address

6705 Park Ave
Pennsauken, NJ 08109
Phone (856) 662-0017

Other identifiers 1

IdentifierTypeStateIssuer
4761405MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100129000608 NJ Practitioner - Family Practice 3678533148 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York College of Osteo Medicine of New York Institute of Technology, 1985
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

6705 Park Ave
Pennsauken, NJ 08109-2480
Phone (856) 662-0017

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
MB048807NJMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Care Associates P a Family Medicine CurrentSince Feb 16, 1989 Accepting new patients
Meridian Counseling Services, LLC Past Accepting new patients

Locations

6705 Park Ave
Pennsauken, NJ 08109
Phone (609) 662-0017

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306195200000",
    "number": "1366482630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6705 PARK AVE",
            "city": "PENNSAUKEN",
            "state": "NJ",
            "postal_code": "08109",
            "telephone_number": "856-662-0017",
            "fax_number": "856-662-6016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6705 PARK AVE",
            "city": "PENNSAUKEN",
            "state": "NJ",
            "postal_code": "08109",
            "telephone_number": "856-662-0017",
            "fax_number": "856-662-6016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICIGLIANO",
        "first_name": "MARK",
        "middle_name": "A",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2011-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "MB048807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4761405",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pennsauken, NJ

Sources for this page

Verify at the official NPI Registry.