Provider Demographics
NPI:1790060069
Name:RIEDINGER, PAUL J (BS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:RIEDINGER
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 ROUTE 46
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-2900
Mailing Address - Country:US
Mailing Address - Phone:973-939-2691
Mailing Address - Fax:973-939-2693
Practice Address - Street 1:1470 ROUTE 46
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-2900
Practice Address - Country:US
Practice Address - Phone:973-939-2691
Practice Address - Fax:973-939-2693
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02161300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI02161300OtherPHARMACIST LICENSE