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General NPI Number Information
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NPI Number | 1518947795
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Entity Type | Individual
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Provider Name | RICHARD JOHN MUCOWSKI EDD, PHD
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Gender | Male
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Dates
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Enumeration Date | 01/22/2006
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Last Update Date | 07/06/2018
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Provider Practice Location Address
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Address Line | 475 MARKET ST FRANCISCARE
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City | ELMWOOD PARK
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State | NJ
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Zip | 07407-3126
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Country | US
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Telephone | 201-791-1499
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Fax | 201-791-3529
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Provider Business Mailing Address
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Address Line | 337 MARKET ST STE 4
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City | SADDLE BROOK
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State | NJ
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Zip | 07663-5313
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Country | US
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Telephone | 201-791-1499
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Fax | 201-791-3529
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | SI 1593
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License Number State | NJ
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