Provider Demographics
NPI:1548383391
Name:FLETCHER, RICHARD DAVID (NP)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:DAVID
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 BROADWAY APT 3A
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-2583
Mailing Address - Country:US
Mailing Address - Phone:201-436-5551
Mailing Address - Fax:
Practice Address - Street 1:NEW HORIZONS
Practice Address - Street 2:844 MCCARTER HIGHWAY
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102
Practice Address - Country:US
Practice Address - Phone:973-484-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331749-1363LF0000X
NJ26NC09495600363LP0808X
NYF400454-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health