Provider Demographics
NPI:1568525947
Name:EGGERT, RICHARD W
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:EGGERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9408 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7301
Mailing Address - Country:US
Mailing Address - Phone:718-745-2229
Mailing Address - Fax:718-745-0497
Practice Address - Street 1:9408 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7301
Practice Address - Country:US
Practice Address - Phone:718-745-2229
Practice Address - Fax:718-745-0497
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004698111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0043044OtherGHI INSURANCE #
NY1329563002OtherCIGNA HMO #
NY33708OtherAETNA #
NY605075OtherACN NETWORK #
NYC046989OtherWORKERS' COMP #
NYP46457085OtherMULTI PLAN NETWORK #
NYP858667OtherOXFORD NETWORK #
NYP858667OtherOXFORD NETWORK #
NY1329563002OtherCIGNA HMO #