Riverdel Medical Practice, Pc | |
302 Clay St. Riverside NJ 08075 | |
(856) 461-7755 | |
(856) 461-2699 |
Full Name | Riverdel Medical Practice, Pc |
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Speciality | Clinic/Center |
Location | 302 Clay St., Riverside, New Jersey |
Authorized Official Name and Position | Evacueto P. Tangco (OWNER) |
Authorized Official Contact | 8564617755 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Riverdel Medical Practice, Pc 302 Clay St. Riverside NJ 08075 Ph: (856) 461-7755 | Riverdel Medical Practice, Pc 302 Clay St. Riverside NJ 08075 Ph: (856) 461-7755 |
NPI Number | 1487693164 |
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Provider Enumeration Date | 06/06/2006 |
Last Update Date | 08/22/2020 |
Medicare PECOS PAC ID | 4880590942 |
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Medicare Enrollment ID | O20031209001056 |
Identifier | Type | State | Issuer |
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1487693164 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | 25MA03673200 (New Jersey) | Primary |
Provider Name | Evacueto Tangco |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1154367225 PECOS PAC ID: 2860398922 Enrollment ID: I20040114000212 |
Jonathan T Wiseman Do Pa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 129 Bridgeboro St, Riverside, NJ 08075 Phone: 856-461-0766 Fax: 215-523-9281 |