| Riverdel Medical Practice, Pc | |
|
302 Clay St. Riverside NJ 08075 | |
| (856) 461-7755 | |
| (856) 461-2699 |
| Full Name | Riverdel Medical Practice, Pc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 302 Clay St., Riverside, New Jersey |
| Authorized Official Name and Position | Evacueto P. Tangco (OWNER) |
| Authorized Official Contact | 8564617755 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Riverdel Medical Practice, Pc 302 Clay St. Riverside NJ 08075 Ph: (856) 461-7755 | Riverdel Medical Practice, Pc 302 Clay St. Riverside NJ 08075 Ph: (856) 461-7755 |
| NPI Number | 1487693164 |
|---|---|
| Provider Enumeration Date | 06/06/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487693164 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 25MA03673200 (New Jersey) | Primary |
Jonathan T Wiseman Do Pa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 129 Bridgeboro St, Riverside, NJ 08075 Phone: 856-461-0766 Fax: 215-523-9281 |