Provider Demographics
NPI:1932356169
Name:UNGERLEIDER, RICHARD S (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:UNGERLEIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-1735
Mailing Address - Country:US
Mailing Address - Phone:732-872-2220
Mailing Address - Fax:
Practice Address - Street 1:22 BAYSIDE DR
Practice Address - Street 2:
Practice Address - City:ATLANTIC HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07716-1735
Practice Address - Country:US
Practice Address - Phone:732-872-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM078482080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology