Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | MD01214 | NJ |
Y | 222Z00000X | Podiatrist | MD01214 | NJ |
N | 213EP0504X | Public Medicine | MD01214 | NJ |
N | 213EP1101X | Primary Podiatric Medicine | MD01214 | NJ |
N | 111NR0200X | Radiology | MD01214 | NJ |
N | 213ER0200X | Radiology | MD01214 | NJ |
N | 2081S0010X | Sports Medicine | MD01214 | NJ |
N | 213ES0000X | Sports Medicine | MD01214 | NJ |
N | 213ES0131X | Foot Surgery | MD01214 | NJ |
NPI | 1104827914 |
---|---|
Provider Name | Dr. Richard Primavera |
First Address | Ocean, NJ 07712-8702 |
Second Address | Long Branch, NJ 07740-5403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 31/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T73022 | (02) | NJ |