Provider Demographics
NPI:1790839017
Name:PODELL, RICHARD NEAL (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:NEAL
Last Name:PODELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:253 DALE DR
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-1513
Mailing Address - Country:US
Mailing Address - Phone:973-376-4130
Mailing Address - Fax:973-218-8134
Practice Address - Street 1:105 MORRIS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1327
Practice Address - Country:US
Practice Address - Phone:973-218-9191
Practice Address - Fax:973-218-1199
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA27312207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ440172MA2Medicare ID - Type UnspecifiedMEDICARE BILLING #
NJC54455Medicare UPIN