Provider Demographics
NPI:1205881729
Name:MACZUGA, RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:MACZUGA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 HUMPHREY AVENUE
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-1135
Mailing Address - Country:US
Mailing Address - Phone:201-823-0408
Mailing Address - Fax:
Practice Address - Street 1:1160 KENNEDY BLVD.
Practice Address - Street 2:ENTRANCE ON 51ST. STREET
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3128
Practice Address - Country:US
Practice Address - Phone:201-823-0303
Practice Address - Fax:201-436-6180
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00234100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ503351PKSMedicare ID - Type Unspecified