Provider Demographics
NPI:1477663243
Name:PARROTTA, RITCHIE J (DO)
Entity Type:Individual
Prefix:
First Name:RITCHIE
Middle Name:J
Last Name:PARROTTA
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 1:9 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00961404Medicaid
NY00961404Medicaid
NYC59407Medicare UPIN
NY51319AMedicare ID - Type Unspecified