Healthcare Provider Details

I. General information

NPI: 1538585443
Provider Name (Legal Business Name): RICHARD J. WALDRON, PH.D., RN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2014
Last Update Date: 03/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PIERMONT RD
CLOSTER NJ
07624-1533
US

IV. Provider business mailing address

20 PIERMONT RD
CLOSTER NJ
07624-1533
US

V. Phone/Fax

Practice location:
  • Phone: 201-750-0505
  • Fax: 201-750-9752
Mailing address:
  • Phone: 201-750-0505
  • Fax: 201-750-9752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number00274200
License Number StateNJ

VIII. Authorized Official

Name: DR. RICHARD JAMES WALDRON
Title or Position: PRESIDENT
Credential: PH.D., APRN, BC
Phone: 201-750-0505