Provider Demographics
NPI:1417905043
Name:DANIELS, RICHARD J (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:DANIELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5220
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754-5220
Mailing Address - Country:US
Mailing Address - Phone:732-349-3838
Mailing Address - Fax:732-349-2233
Practice Address - Street 1:54 BEY LEA RD
Practice Address - Street 2:SUITE 1
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2978
Practice Address - Country:US
Practice Address - Phone:732-616-1801
Practice Address - Fax:215-744-6724
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43015102072085R0204X
PAMD057930L2086S0129X
NJ25MA069108002086S0129X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1172539OtherAETNA HMO
PA5398994OtherCIGNA HMO/PPO
PA0017531500001Medicaid
PA2100067000OtherAMERIHEALTH/INTERCOUNTY
PA30026847OtherKEYSTONE MERCY
NJ8010005Medicaid
PA1413260OtherHIGHMARK BLUE SHIELD
PA2100067000OtherIBC - PC/KHPE
PA7034415OtherAETNA PPO
PA5398994OtherCIGNA HMO/PPO
NJ8010005Medicaid
PA025708T92Medicare ID - Type Unspecified