Provider Demographics
NPI:1811128788
Name:CORNERSTONE PEDIATRICS RICHARD C. HAN M.D., PC
Entity type:Organization
Organization Name:CORNERSTONE PEDIATRICS RICHARD C. HAN M.D., PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-894-8829
Mailing Address - Street 1:401 S VAN BRUNT ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4600
Mailing Address - Country:US
Mailing Address - Phone:201-894-8829
Mailing Address - Fax:201-894-8859
Practice Address - Street 1:401A S VAN BRUNT ST STE 201
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4600
Practice Address - Country:US
Practice Address - Phone:201-894-8829
Practice Address - Fax:201-894-8859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07433600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty