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General NPI Number Information
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NPI Number | 1245286640
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Entity Type | Organization
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Legal Business Name | RIDDLE MEDICAL LLC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 11/20/2013
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Provider Practice Location Address
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Address Line | 401 SYLVAN PL
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City | HAWORTH
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State | NJ
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Zip | 07641-1729
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Country | US
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Telephone | 201-618-1818
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 29
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City | HAWORTH
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State | NJ
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Zip | 07641-0029
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Country | US
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Telephone | 201-512-9494
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALBERT RIDDLE
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Credential | MD
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Telephone | 201-618-1818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | MA177617
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License Number State | NJ
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