Provider Demographics
NPI:1821374653
Name:BALDOVINO, RICHE
Entity Type:Individual
Prefix:
First Name:RICHE
Middle Name:
Last Name:BALDOVINO
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 1:625 TILDEN AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-1845
Mailing Address - Country:US
Mailing Address - Phone:646-769-0469
Mailing Address - Fax:
Practice Address - Street 1:625 TILDEN AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-1845
Practice Address - Country:US
Practice Address - Phone:646-769-0469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01048100225100000X
NY62 023652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist