Provider Demographics
NPI:1073516092
Name:BELLI, RICHARD ANTHONY JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ANTHONY
Last Name:BELLI
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 1:5010 SKILLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4156
Mailing Address - Country:US
Mailing Address - Phone:718-672-3421
Mailing Address - Fax:718-672-3441
Practice Address - Street 1:5010 SKILLMAN AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4156
Practice Address - Country:US
Practice Address - Phone:718-672-3421
Practice Address - Fax:718-672-3441
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002833213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY34848Medicare ID - Type Unspecified
NYT31870Medicare UPIN
NY4709240001Medicare NSC