Provider Demographics
NPI:1306032545
Name:WYNANTSKILL FAMILY PRACTICE P.C.
Entity Type:Organization
Organization Name:WYNANTSKILL FAMILY PRACTICE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RITCHIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARROTTA
Authorized Official - Suffix:
Authorized Official - Credentials:D0
Authorized Official - Phone:518-283-1974
Mailing Address - Street 1:9 W SAND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WYNANTSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12198-7954
Mailing Address - Country:US
Mailing Address - Phone:518-283-1974
Mailing Address - Fax:518-283-2018
Practice Address - Street 1:9 W SAND LAKE RD
Practice Address - Street 2:
Practice Address - City:WYNANTSKILL
Practice Address - State:NY
Practice Address - Zip Code:12198-7954
Practice Address - Country:US
Practice Address - Phone:518-283-1974
Practice Address - Fax:518-283-2018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
53191AMedicare PIN