Provider Demographics
NPI:1003905688
Name:MAROTTO, RICHARD JR (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MAROTTO
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E ROE BLVD
Mailing Address - Street 2:PATCHOGUE MEDICAL GROUP
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2631
Mailing Address - Country:US
Mailing Address - Phone:631-475-3900
Mailing Address - Fax:631-475-5166
Practice Address - Street 1:1 E ROE BLVD
Practice Address - Street 2:PATCHOGUE MEDICAL GROUP
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2631
Practice Address - Country:US
Practice Address - Phone:631-475-3900
Practice Address - Fax:631-475-5166
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005101213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A400228137OtherMEDICARE
NY01453992Medicaid
NYP64101Medicare PIN
NY01453992Medicaid