Provider Demographics
NPI:1518947795
Name:MUCOWSKI, RICHARD JOHN (EDD, PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOHN
Last Name:MUCOWSKI
Suffix:
Gender:M
Credentials:EDD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 MARKET ST
Mailing Address - Street 2:STE 4
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-5313
Mailing Address - Country:US
Mailing Address - Phone:201-791-1499
Mailing Address - Fax:201-791-3529
Practice Address - Street 1:475 MARKET ST
Practice Address - Street 2:FRANCISCARE
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-3126
Practice Address - Country:US
Practice Address - Phone:201-791-1499
Practice Address - Fax:201-791-3529
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-22
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI 1593103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ056650Medicare ID - Type UnspecifiedPSYCHOLOGIST