Healthcare Provider Details

I. General information

NPI: 1013040435
Provider Name (Legal Business Name): AMANNDA L. RICHLINE, DPM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 GREENWICH ST
BELVIDERE NJ
07823-1421
US

IV. Provider business mailing address

4 GREENWICH ST
BELVIDERE NJ
07823-1421
US

V. Phone/Fax

Practice location:
  • Phone: 908-475-8750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberMD02394
License Number StateNJ

VIII. Authorized Official

Name: AMANNDA RICHLINE
Title or Position: DOCTOR
Credential:
Phone: 908-475-8750