Provider Demographics
NPI:1518041557
Name:HOETZEL, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:HOETZEL
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 1:310 W 80TH ST
Mailing Address - Street 2:APT 6A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5788
Mailing Address - Country:US
Mailing Address - Phone:212-580-1224
Mailing Address - Fax:212-632-4495
Practice Address - Street 1:310 W 80TH ST
Practice Address - Street 2:APT 6A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5788
Practice Address - Country:US
Practice Address - Phone:212-580-1224
Practice Address - Fax:212-632-4495
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1245622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY24A341Medicare ID - Type Unspecified