Provider Demographics
NPI:1790762706
Name:VAZ, RICHARD (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:VAZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 NEWTON SPARTA RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2769
Mailing Address - Country:US
Mailing Address - Phone:973-579-6300
Mailing Address - Fax:973-579-1524
Practice Address - Street 1:123 NEWTON SPARTA RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2769
Practice Address - Country:US
Practice Address - Phone:973-579-6300
Practice Address - Fax:973-579-1524
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06310900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7192002Medicaid
NJ7192002Medicaid
NJ478770CL6Medicare PIN
NJ478770PXEMedicare PIN
NJG40576Medicare UPIN