Provider Demographics
NPI:1467607911
Name:RICHARDSON SURGICAL, LLC
Entity Type:Organization
Organization Name:RICHARDSON SURGICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:N
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:II
Authorized Official - Credentials:APN
Authorized Official - Phone:609-646-6025
Mailing Address - Street 1:433 NIGHTINGALE SQ
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-5603
Mailing Address - Country:US
Mailing Address - Phone:609-646-6025
Mailing Address - Fax:609-646-6316
Practice Address - Street 1:433 NIGHTINGALE SQUARE
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-5603
Practice Address - Country:US
Practice Address - Phone:609-646-6025
Practice Address - Fax:609-646-6316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00054400363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0070688Medicaid
NJQ43898Medicare UPIN
NJ091065N7JMedicare PIN