Healthcare Provider Details

I. General information

NPI: 1114992773
Provider Name (Legal Business Name): GREGORY SALVATORE RIHACEK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 CLYDE RD #101
SOMERSET NJ
08873-5042
US

IV. Provider business mailing address

19 CLYDE RD SUITE 101
SOMERSET NJ
08873-5042
US

V. Phone/Fax

Practice location:
  • Phone: 732-568-0023
  • Fax: 732-568-0159
Mailing address:
  • Phone: 732-568-0023
  • Fax: 732-568-0159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number25MA06373000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: