Provider Demographics
NPI:1134328073
Name:MASSARELLI, RICHARD T (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:T
Last Name:MASSARELLI
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 1:1084 KENSINGTON TER
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4807
Mailing Address - Country:US
Mailing Address - Phone:908-539-1877
Mailing Address - Fax:908-964-2721
Practice Address - Street 1:1084 KENSINGTON TER
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-4807
Practice Address - Country:US
Practice Address - Phone:908-539-1877
Practice Address - Fax:908-964-2721
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00317100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1661507Medicaid
NJ1661507Medicaid