Provider Demographics
NPI:1063418853
Name:RIEDINGER, ROBERT BLAIR (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BLAIR
Last Name:RIEDINGER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949 OAK TREE RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2036
Mailing Address - Country:US
Mailing Address - Phone:732-549-7117
Mailing Address - Fax:732-549-7080
Practice Address - Street 1:1949 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2036
Practice Address - Country:US
Practice Address - Phone:732-549-7117
Practice Address - Fax:732-549-7080
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00426100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4315901Medicaid
0705600001Medicare ID - Type Unspecified