Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 25MA08296300 | NJ |
NPI | 1275559700 |
---|---|
Provider Name | Kenneth J Rieger |
First Address | Chatham, NJ 07928-2431 |
Second Address | Chatham, NJ 07928-2431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 17/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000485768 | ANTHEM (01) | KY |
000000495770 | ANTHEM (UNIV ORTHO ASSOC) (01) | KY |
01062330A | PHYS.LICENSE (01) | IN |
01062330B | CSR (01) | IN |
200828910 | (05) | IN |
25MA08296300 | LICENSE (01) | NJ |
2785649000 | PASSPORT ADVANTAGE (01) | KY |
2785663000 | PASSPORT ADVANTAGE (UOA) (01) | KY |
40285 | PHYSICIAN LICENSE (01) | KY |
50012858 | PASSPORT (SPINE INSTITUTE (01) | KY |
50012859 | PASSPORT (UNIV ORTHO ASSO (01) | KY |
64125370 | (05) | KY |
BR9641172 | DEA (01) | IN |
BR9816717 | DEA (01) | KY |
P00384745 | RAILROAD MEDICARE (01) | KY |