Provider Demographics
NPI:1326341207
Name:FORBERG, RICHARD A (EMT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:FORBERG
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ADAMS LN
Mailing Address - Street 2:
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-2600
Mailing Address - Country:US
Mailing Address - Phone:609-914-1700
Mailing Address - Fax:
Practice Address - Street 1:16 ADAMS LN
Practice Address - Street 2:
Practice Address - City:HAINESPORT
Practice Address - State:NJ
Practice Address - Zip Code:08036-2600
Practice Address - Country:US
Practice Address - Phone:609-914-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ530134146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ530134OtherNJ DEPT OF HEALTH & SENIOR SERVICES