Provider Demographics
NPI:1740240969
Name:RICHLINE, AMANNDA L (DPM, PC)
Entity Type:Individual
Prefix:
First Name:AMANNDA
Middle Name:L
Last Name:RICHLINE
Suffix:
Gender:F
Credentials:DPM, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GREENWICH ST
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:NJ
Mailing Address - Zip Code:07823-1421
Mailing Address - Country:US
Mailing Address - Phone:908-475-8750
Mailing Address - Fax:
Practice Address - Street 1:4 GREENWICH ST
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:NJ
Practice Address - Zip Code:07823-1421
Practice Address - Country:US
Practice Address - Phone:908-475-8750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD02394213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7691693OtherCIGNA
NJ480032339OtherRAIL ROAD
NJ480032339OtherRAIL ROAD
NJ897854Medicare ID - Type Unspecified
NJ4238680001Medicare NSC