Provider Demographics
NPI:1124028139
Name:STISO, RICHARD A (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:STISO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 RIDGEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2004
Mailing Address - Country:US
Mailing Address - Phone:973-822-1317
Mailing Address - Fax:
Practice Address - Street 1:81 RIDGEDALE AVE
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2004
Practice Address - Country:US
Practice Address - Phone:973-822-1317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00134300111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJX40481OtherWELL CHOICE
NJ5333300Medicaid
NJ561794OtherAETNA
NJ0885115OtherCIGNA
NJ593175OtherUNITEDHEALTHCARE
NJMC01343OtherLANDMARK
NJP421418OtherOXFORD
NJ0103700000OtherAMERIHEALTH
NJ561794OtherAETNA
NJT77864Medicare UPIN