Richard Prus-Wisniewski, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

25MA6817500 Issued in NJ

Practice address

905 Herrontown Rd
Princeton House Behavioral Health
Princeton, NJ 08540-1901

Phone

(609) 497-3300

Fax

(609) 497-3370

NPI assigned

Oct 3, 2006

Last updated

Jan 22, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 7, 2016 through Mar 7, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1232582400000",
    "number": "1558455535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 PRINCESS RD",
            "address_2": "SUITE #207",
            "city": "LAWRENCEVILLE",
            "state": "NJ",
            "postal_code": "086482322",
            "telephone_number": "609-243-0445",
            "fax_number": "609-844-1092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 HERRONTOWN RD",
            "address_2": "PRINCETON HOUSE BEHAVIORAL HEALTH",
            "city": "PRINCETON",
            "state": "NJ",
            "postal_code": "085401901",
            "telephone_number": "609-497-3300",
            "fax_number": "609-497-3370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUS-WISNIEWSKI",
        "first_name": "RICHARD",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2009-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": "25MA6817500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8194602",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ani Qu, LAB DIRECTOR

• Psychiatry Physician in Princeton, NJ
• Providers in Princeton, NJ by specialty
• Psychiatry Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.