Provider Demographics
NPI:1255300141
Name:AFONJA, RICHARDS (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARDS
Middle Name:
Last Name:AFONJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 857
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07015-0857
Mailing Address - Country:US
Mailing Address - Phone:973-594-7977
Mailing Address - Fax:973-594-9983
Practice Address - Street 1:476 COLFAX AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1624
Practice Address - Country:US
Practice Address - Phone:973-594-7977
Practice Address - Fax:973-594-9983
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA61127207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6763901Medicaid
NJ885152Medicare ID - Type Unspecified
NJ6763901Medicaid