Provider Demographics
NPI:1811967995
Name:LISZEWSKI, RICHARD F (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:F
Last Name:LISZEWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:BELLMAWR
Mailing Address - State:NJ
Mailing Address - Zip Code:08099-0635
Mailing Address - Country:US
Mailing Address - Phone:856-566-2700
Mailing Address - Fax:856-566-6873
Practice Address - Street 1:42 LAUREL RD E
Practice Address - Street 2:UDP #2500
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1354
Practice Address - Country:US
Practice Address - Phone:856-566-2700
Practice Address - Fax:856-566-6873
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB02837700208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2290405Medicaid
NJ2290405Medicaid
NJE79604Medicare UPIN