Healthcare Provider Details

I. General information

NPI: 1194728030
Provider Name (Legal Business Name): RICHARD I STILLMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 E WILLOW ST
MILLBURN NJ
07041-1416
US

IV. Provider business mailing address

PO BOX 15275
NEWARK NJ
07192-5275
US

V. Phone/Fax

Practice location:
  • Phone: 973-912-8111
  • Fax:
Mailing address:
  • Phone: 201-804-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA 054103
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: