Provider Demographics
NPI:1588677629
Name:TANCER, RICHARD B
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:TANCER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 UNIVERSITY PLZ STE 205
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18 REDNECK AVE
Practice Address - Street 2:
Practice Address - City:LITTLE FERRY
Practice Address - State:NJ
Practice Address - Zip Code:07643-1382
Practice Address - Country:US
Practice Address - Phone:201-641-3115
Practice Address - Fax:201-641-3116
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB46440207Q00000X
NJ25MB04644000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC54844Medicare UPIN
NJ447502Medicare PIN