1700879921 NPI number — DR. RICHARD ERIC NAIDS M.D.

Table of content: MATTHEW D'ANTONIO DPT (NPI 1295126688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700879921 NPI number — DR. RICHARD ERIC NAIDS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAIDS
Provider First Name:
RICHARD
Provider Middle Name:
ERIC
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700879921
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1874 AUTUMN LEAF LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGDON VALLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19006-1526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-364-6818
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 SUNSET RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLINGBORO
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08046-1109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-877-2800
Provider Business Practice Location Address Fax Number:
609-877-1813
Provider Enumeration Date:
08/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  MD033798E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001118060 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0110141000 . This is a "IBC INDIVIDUAL ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1173655 . This is a "CIGNA INDIVIDUAL ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3615274 . This is a "AETNA INDIVIDUAL ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00166303 . This is a "RR MEDICARE INDIVIDUAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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