Provider Demographics
NPI:1144283235
Name:SCHEUCH, JOHN RAYMOND (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RAYMOND
Last Name:SCHEUCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 PALISADE AVE
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3419
Mailing Address - Country:US
Mailing Address - Phone:201-836-6060
Mailing Address - Fax:206-339-9130
Practice Address - Street 1:870 PALISADE AVE
Practice Address - Street 2:SUITE 201A
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3419
Practice Address - Country:US
Practice Address - Phone:201-836-6060
Practice Address - Fax:206-339-9130
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA42382174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222711833OtherTAX ID
NJ541455Medicare ID - Type UnspecifiedPROVIDER
NJ222711833OtherTAX ID