1275559700 NPI number — KENNETH J RIEGER M.D.

Table of content: KENNETH J RIEGER M.D. (NPI 1275559700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275559700 NPI number — KENNETH J RIEGER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIEGER
Provider First Name:
KENNETH
Provider Middle Name:
J
Provider Name Prefix Text:
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:
1275559700
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHATHAM
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07928-2431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-635-0800
Provider Business Mailing Address Fax Number:
973-635-6254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHATHAM
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07928-2431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-635-0800
Provider Business Practice Location Address Fax Number:
973-635-6254
Provider Enumeration Date:
07/15/2006

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: 207XS0117X , with the licence number:  25MA08296300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2785663000 . This is a "PASSPORT ADVANTAGE (UOA)" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50012859 . This is a "PASSPORT (UNIV ORTHO ASSO" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000485768 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 01062330A . This is a "PHYS.LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00384745 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 25MA08296300 . This is a "LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2785649000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000495770 . This is a "ANTHEM (UNIV ORTHO ASSOC)" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 01062330B . This is a "CSR" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 40285 . This is a "PHYSICIAN LICENSE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50012858 . This is a "PASSPORT (SPINE INSTITUTE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64125370 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200828910 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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