Basic Information
| Provider Information | |||||||||
| NPI: | 1447256706 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIEDER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3625 QUAKERBRIDGE ROAD | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096891600 | ||||||||
| FaxNumber: | 6096891200 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 KUSER RD | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086913302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095858800 | ||||||||
| FaxNumber: | 6095851825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2005 | ||||||||
| LastUpdateDate: | 08/24/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MA05625800 | NJ | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD039307E | PA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | MA05625800 | NJ | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0204X | MD039307E | PA | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0202X | C1-0009674 | DE | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | C1-0009674 | DE | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 01540554 | 05 | PA | MEDICAID | 1447256706 | 05 | DE | MEDICAID | 7345208 | 05 | NJ | MEDICAID |