Healthcare Provider Details

I. General information

NPI: 1477573541
Provider Name (Legal Business Name): EDWARD RICHARD NIEUWENHUIS JR. DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 FRANKLIN AVE SUITE 2
WYCKOFF NJ
07481-1909
US

IV. Provider business mailing address

350 FRANKLIN AVE SUITE 2
WYCKOFF NJ
07481-1909
US

V. Phone/Fax

Practice location:
  • Phone: 201-891-4930
  • Fax: 201-891-4715
Mailing address:
  • Phone: 201-891-4930
  • Fax: 201-891-4715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberMD02125
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: