Provider Demographics
NPI:1053728576
Name:POKORNY, RICHARD (MSTOM)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:POKORNY
Suffix:
Gender:M
Credentials:MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LINDEN PL
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-1602
Mailing Address - Country:US
Mailing Address - Phone:973-766-1837
Mailing Address - Fax:
Practice Address - Street 1:500 LINDEN PL
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-1602
Practice Address - Country:US
Practice Address - Phone:973-766-1837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00049200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist