Provider Demographics
NPI:1134120686
Name:NEIBART, RICHARD M (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:NEIBART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:100 MADISON AVE
Mailing Address - Street 2:MID-ATLANTIC SURGICAL ASSOCIATES
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6136
Mailing Address - Country:US
Mailing Address - Phone:973-971-7300
Mailing Address - Fax:973-984-7019
Practice Address - Street 1:1944 ROUTE 33
Practice Address - Street 2:MID-ATLANTIC SURGICAL ASSOC - SUITE 201
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4862
Practice Address - Country:US
Practice Address - Phone:732-776-4622
Practice Address - Fax:732-776-3765
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ53255208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1657500Medicaid
E52643Medicare UPIN
577969Medicare ID - Type Unspecified