=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407947419
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD ANTHONY IRLANDO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18 HORIZON DRIVE
-----------------------------------------------------
City | MENDHAM
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07945-2304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-543-9926
-----------------------------------------------------
Fax | 973-543-1683
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18 HORIZON DRIVE
-----------------------------------------------------
City | MENDHAM
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07945-2304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-543-9926
-----------------------------------------------------
Fax | 973-543-1683
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | MA39882
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------