| Doctor Name: | DR. RICHARD PRIMAVERA |
| NPI Number: | 1104827914 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM CWS FACFAOM |
| License Number: | MD01214 |
| Business Practice Address: | 179 Norwood Ave Long Branch, NJ - 077405403 |
| Business Phone Number: | 7322223917 |
| Business Fax Number: | 7322220324 |
| Mailing Address: | 50 Redwood Dr, OCEAN |
| State: | NJ |
| Postal Code: | 077128702 |
| Phone Number: | 7326104885 |
| Fax Number: | |
| NPI Enumeration Date: | 08/02/2005 |
| NPI Last Update Date: | 01/31/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213EP0504X |
| License Number: | MD01214 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Public Medicine |
| Taxonomy Definition: | |