Basic Information
Provider Information | |||||||||
NPI: | 1861435885 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RICHMAND | ||||||||
FirstName: | DAVID | ||||||||
MiddleName: | M | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1511 PARK AVE | ||||||||
Address2: |   | ||||||||
City: | SOUTH PLAINFIELD | ||||||||
State: | NJ | ||||||||
PostalCode: | 070805516 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9085619500 | ||||||||
FaxNumber: | 9085617162 | ||||||||
Practice Location | |||||||||
Address1: | 1511 PARK AVE | ||||||||
Address2: |   | ||||||||
City: | SOUTH PLAINFIELD | ||||||||
State: | NJ | ||||||||
PostalCode: | 070805516 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9085619500 | ||||||||
FaxNumber: | 9085617162 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/14/2006 | ||||||||
LastUpdateDate: | 02/21/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 25MA04034400 | NJ | Y |   | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
ID | Type | State | Issuer | Description | 2119740 | 01 | NJ | AETNA | OTHER | 0918232 | 01 | NJ | CIGNA | OTHER | 0141777000 | 01 | NJ | AMERIHEALTH | OTHER | 359183 | 01 | NJ | UNITED HEALTHCARE | OTHER | LS120 | 01 | NJ | OXFORD | OTHER |