Provider Demographics
NPI:1124024732
Name:RICHMAN, DREW AMES (DPM)
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:AMES
Last Name:RICHMAN
Suffix:
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 1:1418 ROUTE 300
Mailing Address - Street 2:STE 6
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-2992
Mailing Address - Country:US
Mailing Address - Phone:845-566-6664
Mailing Address - Fax:845-566-1911
Practice Address - Street 1:1418 ROUTE 300
Practice Address - Street 2:STE 6
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2994
Practice Address - Country:US
Practice Address - Phone:845-566-6664
Practice Address - Fax:845-566-1911
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN00 2356-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00524869Medicaid
T71170Medicare UPIN
NYP28681Medicare ID - Type Unspecified