Provider Demographics
NPI:1538164975
Name:PUMILL, RICK (MD)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:
Last Name:PUMILL
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 1:103 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1010
Mailing Address - Country:US
Mailing Address - Phone:201-941-8100
Mailing Address - Fax:201-941-2899
Practice Address - Street 1:103 RIVER RD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1010
Practice Address - Country:US
Practice Address - Phone:201-941-8100
Practice Address - Fax:201-941-2899
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05187300207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJBP176OtherOXFORD ID #
NJ0K7706OtherHEALTHNET ID #
NJ4261300OtherAETNA PPO ID #
NJ2018705Medicaid
NJ25585OtherAETNA HMO ID #
NJ0074887000OtherAMERIHEALTH GROUP #
NJ73F081OtherEMPIRE BC/BS OF NY ID #
NJ0090117OtherGHI PPO ID #
NJ0K7706OtherHEALTHNET ID #
NJBP176OtherOXFORD ID #