Provider Demographics
NPI:1578882338
Name:NEIDERHOFER, PAUL KEVIN (RP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:KEVIN
Last Name:NEIDERHOFER
Suffix:
Gender:M
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-4313
Mailing Address - Country:US
Mailing Address - Phone:201-384-1147
Mailing Address - Fax:201-384-1625
Practice Address - Street 1:425 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-4313
Practice Address - Country:US
Practice Address - Phone:201-384-1147
Practice Address - Fax:201-384-1625
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01699200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist