Provider Demographics
NPI:1013040435
Name:AMANNDA L. RICHLINE, DPM, PC
Entity Type:Organization
Organization Name:AMANNDA L. RICHLINE, DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-475-8750
Mailing Address - Street 1:4 GREENWICH ST
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:NJ
Mailing Address - Zip Code:07823-1421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 GREENWICH ST
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:NJ
Practice Address - Zip Code:07823-1421
Practice Address - Country:US
Practice Address - Phone:908-475-8750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD02394213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ480027065OtherMEDICARE, RAILROAD
NJ4238680001Medicare NSC
NJ480027065OtherMEDICARE, RAILROAD