Provider Demographics
NPI:1083021703
Name:RICHARD A.MINGIONEMD
Entity Type:Organization
Organization Name:RICHARD A.MINGIONEMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TASHIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:609-347-7135
Mailing Address - Street 1:4127 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-5829
Mailing Address - Country:US
Mailing Address - Phone:609-347-7135
Mailing Address - Fax:609-347-6336
Practice Address - Street 1:4127 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-5829
Practice Address - Country:US
Practice Address - Phone:609-347-7135
Practice Address - Fax:609-347-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA37937261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC55215Medicare UPIN
NJ451510Medicare PIN