Provider Demographics
NPI:1023012952
Name:MAURIELLO, RICHARD M (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:MAURIELLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 CROSS KEYS RD # 300A
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-9263
Mailing Address - Country:US
Mailing Address - Phone:856-767-0077
Mailing Address - Fax:856-767-6102
Practice Address - Street 1:175 CROSS KEYS RD # 300A
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-9263
Practice Address - Country:US
Practice Address - Phone:856-767-0077
Practice Address - Fax:856-767-6102
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB32129207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMB32129OtherLICENSE
NJ551133Medicare PIN
NJMB32129OtherLICENSE