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Riverdel Medical Practice, PC

Organization Active NPI Primary Care Clinic/Center · Riverside, NJ

NPI 1487693164 · NPPES record last updated Aug 22, 2020

Key facts

NPI
1487693164
Entity type
Organization (NPI type 2)
Primary specialty
Primary Care Clinic/Center 261QP2300X
License
25MA03673200 (NJ)
Legal business name
RIVERDEL MEDICAL PRACTICE, PC
Practice address
302 Clay St.
Riverside, NJ 08075
Phone
(856) 461-7755
Fax
(856) 461-2699
NPI assigned
Jun 6, 2006
Organization subpart
No

Authorized official

Name
Dr. Evacueto P. Tangco, M.D.
Title
Owner
Phone
(856) 461-7755

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D1018653Riverdel Medical Practice PC
302 Clay Street, Riverside, NJ 08075		Certificate of waiverOct 27, 2027

National Provider Directory

Locations

302 Clay St
Delran, NJ 08075
Phone (609) 461-7755

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 25MA03673200 NJ Yes

Addresses

Primary practice location

302 Clay St.
Riverside, NJ 08075

Mailing address

302 Clay St.
Riverside, NJ 08075
Phone (856) 461-7755

Other providers in Riverside, NJ

All providers in Riverside, NJ · Primary Care Clinic/Center in New Jersey

Sources for this page

Verify at the official NPI Registry.