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HENRIETA RICCOBONO DNP
NPI 1174296511
Nurse Practitioner - Acute Care in Passaic, NJ

Active since July 30, 2021PECOS Enrolled
350 BOULEVARD, PASSAIC, NJ 07055(973) 365-4387 Get Directions Write a Review

NPPES record last updated: July 30, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Henrieta Riccobono Dnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HENRIETA RICCOBONO DNP (NPI 1174296511) is an individual acute care provider in Passaic, New Jersey, licensed in New Jersey (26NJ01183100) and active in the NPI registry since July 2021. She is enrolled in Medicare PECOS and is a graduate of Other (2021).

NPPES Registry Identity

NPI1174296511
Entity TypeIndividualFemale
Primary Taxonomy363LA2100X
Provider Legal NameHENRIETA RICCOBONOCredential: DNP
Location Address350 BOULEVARDPassaic, NJ 07055-2840
Mailing Address350 BoulevardPassaic, NJ 07055-2840 · (973) 365-4387
Phone(973) 365-4387
Sole ProprietorYes
Medical School CMSOtherGraduated 2021
Enumeration DateJuly 30, 2021
NPPES CertifiedJuly 8, 2021
✔ NPI 1174296511 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Acute CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2100X
License✔ Licensed in NJ · 26NJ01183100
350 BOULEVARD, Passaic, NJ 07055
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Henrieta Riccobono Dnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5496144628
PECOS Enrollment IDI20251013001038
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Henrieta Riccobono reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

St Marys General Medical Group PC
Same address
Internal Medicine
350 BOULEVARD
Passaic, NJ 07055
  • Reassigned Medicare billing, New Jersey enrollment
  • 101 clinicians in this Medicare group
NPI 1477261741 (973) 365-4300

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 07055 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$98.09 typical visit price
range $63.84 – $190.92
Typical copayment $24.52 (range $15.96 – $47.73)
Most-billed visit code 99203
Established Patient
$111.57 typical visit price
range $20.97 – $155.92
Typical copayment $27.89 (range $5.24 – $38.98)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims 3

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) A4221
DME-Other DME · category DE017N
1 supplier11 claims11 services$18.41 avg. paid by Medicare
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) A4222
DME-Medical/Surgical Supplies · category DA000N
1 supplier11 claims40 services$35.86 avg. paid by Medicare
Injection, milrinone lactate, 5 mg J2260
Treatment-Injections and Infusions (nononcologic) · category RI026N
1 supplier11 claims400 services$1.28 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ASHWIN NELLIPARAMBIL JITHEESH
Student in an Organized Health Care Education/Training Program
350 BOULEVARD, ST. MARY'S HOSPITAL MEMORIAL BUILDING, ROOM 416
PASSAIC, NJ 07055
Passaic County (404) 503-3936
BAY RADIATION ONCOLOGY,P.L.L.C
Radiology (Therapeutic Radiology)
350 BOULEVARD
PASSAIC, NJ 07055
Passaic County (973) 365-5088
EMERGENCY PHYSICIAN ASSOCIATES OF NORTH JERSEY, PC
Emergency Medicine
350 BOULEVARD
PASSAIC, NJ 07055
Passaic County (856) 686-4306
ROYAL RX INC
Pharmacy (Community/Retail Pharmacy)
350 BOULEVARD
PASSAIC, NJ 07055
Passaic County (973) 365-7143
DR. CHANG J LEE MD
Anesthesiology
350 BOULEVARD
PASSAIC, NJ 07055
Passaic County (973) 779-7361
RON JAKO DARANTINAO DOMINGO
Student in an Organized Health Care Education/Training Program
350 BOULEVARD
PASSAIC, NJ 07055
Passaic County (732) 910-1335
JOHN P. HALLENBECK DO
Emergency Medicine
350 BOULEVARD
PASSAIC, NJ 07055
Passaic County (973) 365-4489
MARGARET J WU M.D.
Anesthesiology
350 BOULEVARD
PASSAIC, NJ 07055
Passaic County (973) 365-4300

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Henrieta Riccobono's NPI number?

The NPI number for Henrieta Riccobono is 1174296511. It was assigned to this individual provider in the NPPES registry on July 30, 2021.

Where is Henrieta Riccobono located?

Henrieta Riccobono practices at 350 Boulevard, Passaic, NJ 07055. The listed phone number is (973) 365-4387.

What is Henrieta Riccobono's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Acute Care, with taxonomy code 363LA2100X.

Is Henrieta Riccobono enrolled in Medicare?

Yes. Henrieta Riccobono is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Henrieta Riccobono's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Henrieta Riccobono reassigns Medicare benefits to St Marys General Medical Group PC (Passaic, NJ). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Henrieta Riccobono's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Henrieta Riccobono was last updated on July 30, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.