Provider Demographics
NPI:1225164627
Name:RISKO, RICHARD T (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:T
Last Name:RISKO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 JERUSALEM AVE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-2020
Mailing Address - Country:US
Mailing Address - Phone:516-785-4815
Mailing Address - Fax:516-785-4815
Practice Address - Street 1:2929 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2020
Practice Address - Country:US
Practice Address - Phone:516-785-4815
Practice Address - Fax:516-785-4815
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124577207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY42656OtherAETNA
NY389551Medicaid
NYAP793OtherOXFORD
NY389551Medicaid
NYAP793OtherOXFORD