Healthcare Provider Details

I. General information

NPI: 1114092236
Provider Name (Legal Business Name): RICHARD A WINTERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 NORTH FARVIEW AVENUE
PARAMUS NJ
07652-2717
US

IV. Provider business mailing address

29 N FARVIEW AVE
PARAMUS NJ
07652-2738
US

V. Phone/Fax

Practice location:
  • Phone: 201-843-4944
  • Fax: 201-265-7647
Mailing address:
  • Phone: 201-843-4944
  • Fax: 201-265-7647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number027902
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number116388
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: