Provider Demographics
NPI:1700924727
Name:RICKERHAUSER-KRALL, MAUREEN A (MD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:A
Last Name:RICKERHAUSER-KRALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 BERGEN ST
Mailing Address - Street 2:ADMC 12 1205
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-3000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 BERGEN ST
Practice Address - Street 2:PEDIATRIC E.R
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2496
Practice Address - Country:US
Practice Address - Phone:973-972-5139
Practice Address - Fax:973-972-5965
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA044390002080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1257609Medicaid
NJ1257609Medicaid
NJE87610Medicare UPIN