Provider Demographics
NPI:1699102277
Name:ROBERT W RICHARDSON MD LLC
Entity type:Organization
Organization Name:ROBERT W RICHARDSON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-667-4568
Mailing Address - Street 1:181 FRANKLIN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3820
Mailing Address - Country:US
Mailing Address - Phone:973-667-4568
Mailing Address - Fax:973-667-4589
Practice Address - Street 1:181 FRANKLIN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3820
Practice Address - Country:US
Practice Address - Phone:973-667-4568
Practice Address - Fax:973-667-4589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03545600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty