MEDICARE: DR. RICK PUMILL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	25MA05187300	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BP176	OTHER	NJ	OXFORD ID #
2	0K7706	OTHER	NJ	HEALTHNET ID #
3	4261300	OTHER	NJ	AETNA PPO ID #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	25585	OTHER	NJ	AETNA HMO ID #
6	0074887000	OTHER	NJ	AMERIHEALTH GROUP #
7	73F081	OTHER	NJ	EMPIRE BC/BS OF NY ID #
8	0090117	OTHER	NJ	GHI PPO ID #

General Provider Information

NPI Number	:	1538164975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICK PUMILL M.D.

Provider Business Mailing Address
First Line	:	103 RIVER RD
Second Line	:
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1010
Country	:	US
Telephone Number	:	201-941-8100
Fax Number	:	201-941-2899

Provider Business Practice Location Address
First Line	:	103 RIVER RD
Second Line	:
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1010
Country	:	US
Telephone Number	:	201-941-8100
Fax Number	:	201-941-2899

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	04/15/2008

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Directions to “ DR. RICK PUMILL M.D.” Practice Location

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