Provider Demographics
NPI:1679533798
Name:TADDEO, RICHARD MICHAEL
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MICHAEL
Last Name:TADDEO
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 1:120 MILLBURN AVE
Mailing Address - Street 2:#102
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1942
Mailing Address - Country:US
Mailing Address - Phone:973-376-0700
Mailing Address - Fax:973-376-5401
Practice Address - Street 1:120 MILLBURN AVE
Practice Address - Street 2:#102
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1942
Practice Address - Country:US
Practice Address - Phone:973-376-0700
Practice Address - Fax:973-376-5401
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD02383213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU66401Medicare UPIN
NJ024737Medicare PIN