Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 25MA02760500 | NJ |
Y | 2080A0000X | Adolescent Medicine | 25MA02760500 | NJ |
N | 2080P0006X | Developmental - Behavioral Pediatrician | 25MA02760500 | NJ |
NPI | 1225089923 |
---|---|
Provider Name | Dr. Richard A Reutter |
First Address | Long Branch, NJ 07740-6311 |
Second Address | Long Branch, NJ 07740-6311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 07/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1995103 | (05) | NJ |
C55748 | (02) | NJ |