Provider Demographics
NPI:1275559700
Name:RIEGER, KENNETH J (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:RIEGER
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 1:40 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2431
Mailing Address - Country:US
Mailing Address - Phone:973-635-0800
Mailing Address - Fax:973-635-6254
Practice Address - Street 1:40 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2431
Practice Address - Country:US
Practice Address - Phone:973-635-0800
Practice Address - Fax:973-635-6254
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08296300207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2785663000OtherPASSPORT ADVANTAGE (UOA)
KY50012859OtherPASSPORT (UNIV ORTHO ASSO
KY000000485768OtherANTHEM
IN01062330AOtherPHYS.LICENSE
KYP00384745OtherRAILROAD MEDICARE
NJ25MA08296300OtherLICENSE
KY2785649000OtherPASSPORT ADVANTAGE
KY000000495770OtherANTHEM (UNIV ORTHO ASSOC)
IN01062330BOtherCSR
KY40285OtherPHYSICIAN LICENSE
KY50012858OtherPASSPORT (SPINE INSTITUTE
KY64125370Medicaid
IN200828910Medicaid
KYBR9816717OtherDEA
IN200828910Medicaid
KY50012859OtherPASSPORT (UNIV ORTHO ASSO
NJP00384745Medicare PIN
KY0605939Medicare PIN
KY2785649000OtherPASSPORT ADVANTAGE