Provider Demographics
NPI:1518964691
Name:GORECKI, RICHARD T (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:T
Last Name:GORECKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 138
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-0138
Mailing Address - Country:US
Mailing Address - Phone:203-245-9202
Mailing Address - Fax:
Practice Address - Street 1:1353 BOSTON POST RD
Practice Address - Street 2:STE 6
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3403
Practice Address - Country:US
Practice Address - Phone:203-245-9202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000072213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004006656Medicaid
CT480000234Medicare ID - Type Unspecified
CTT23145Medicare UPIN