Provider Demographics
NPI:1184733792
Name:WALDRON, RICHARD JAMES (PHD APRN BC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAMES
Last Name:WALDRON
Suffix:
Gender:M
Credentials:PHD APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PIERMONT RD
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-1533
Mailing Address - Country:US
Mailing Address - Phone:201-750-0505
Mailing Address - Fax:201-750-9752
Practice Address - Street 1:20 PIERMONT RD
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-1533
Practice Address - Country:US
Practice Address - Phone:201-750-0505
Practice Address - Fax:201-750-9752
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ335I00274200103T00000X
NJ26NJ00092200163WP0809X
NJ26N012450000163W00000X
NJP00195800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
644839Medicare UPIN