Provider Demographics
NPI:1326085549
Name:DRANITZKE, RICHARD J (MD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:J
Last Name:DRANITZKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 BELLE TERRE ROAD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:17777
Mailing Address - Country:US
Mailing Address - Phone:631-473-1602
Mailing Address - Fax:631-473-5814
Practice Address - Street 1:635 BELLE TERRE ROAD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:17777
Practice Address - Country:US
Practice Address - Phone:631-473-5814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099574208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00335731Medicaid
971762Medicare ID - Type Unspecified
NY00335731Medicaid