Provider Demographics
NPI:1720164759
Name:HULSE, RICHARD D (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:D
Last Name:HULSE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-4906
Mailing Address - Country:US
Mailing Address - Phone:732-556-6449
Mailing Address - Fax:
Practice Address - Street 1:1944 STATE HIGHWAY 33
Practice Address - Street 2:JERSEY SHORE UNIVERSITY MEDICAL CENTER
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07754
Practice Address - Country:US
Practice Address - Phone:732-776-4622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00134000363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical