Provider Demographics
NPI:1043233513
Name:RICHARD, MERWIN F (MD)
Entity Type:Individual
Prefix:
First Name:MERWIN
Middle Name:F
Last Name:RICHARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:550 NEWARK AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1326
Mailing Address - Country:US
Mailing Address - Phone:201-418-9111
Mailing Address - Fax:201-418-9118
Practice Address - Street 1:550 NEWARK AVE
Practice Address - Street 2:STE 307
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1326
Practice Address - Country:US
Practice Address - Phone:201-418-9111
Practice Address - Fax:201-418-9118
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2013-11-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA07291400207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8650501Medicaid
NJ8650501Medicaid
NJH50031Medicare UPIN