Provider Demographics
NPI:1972178721
Name:RICHARDS, MAUREEN L (NP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:L
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 CRESTMONT RD
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1626
Mailing Address - Country:US
Mailing Address - Phone:914-204-1455
Mailing Address - Fax:
Practice Address - Street 1:63 CRESTMONT RD
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1626
Practice Address - Country:US
Practice Address - Phone:914-204-1455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01059900207QA0505X, 363LA2200X, 363LG0600X, 363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology