Provider Demographics
NPI:1326256983
Name:RA PODIATRY PC
Entity Type:Organization
Organization Name:RA PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:AMATO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-378-9191
Mailing Address - Street 1:2116 MERRICK AVE
Mailing Address - Street 2:SUITE 3008
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3445
Mailing Address - Country:US
Mailing Address - Phone:516-378-9191
Mailing Address - Fax:516-378-2911
Practice Address - Street 1:2116 MERRICK AVE
Practice Address - Street 2:SUITE 3008
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3445
Practice Address - Country:US
Practice Address - Phone:516-378-9191
Practice Address - Fax:516-378-2911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002590213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00415072Medicaid
NY00415072Medicaid
NYT-50833Medicare UPIN
NY5040110001Medicare NSC