Provider Demographics
NPI:1578652400
Name:HERITAGE PODIATRY, INC.
Entity Type:Organization
Organization Name:HERITAGE PODIATRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RICCITELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:401-567-9288
Mailing Address - Street 1:5 MONEY HILL ROAD
Mailing Address - Street 2:PO BOX 731
Mailing Address - City:CHEPACHET
Mailing Address - State:RI
Mailing Address - Zip Code:02814
Mailing Address - Country:US
Mailing Address - Phone:401-567-9288
Mailing Address - Fax:401-567-7785
Practice Address - Street 1:5 MONEY HILL ROAD
Practice Address - Street 2:
Practice Address - City:CHEPACHET
Practice Address - State:RI
Practice Address - Zip Code:02814
Practice Address - Country:US
Practice Address - Phone:401-567-9288
Practice Address - Fax:401-567-7785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI489023611Medicare ID - Type Unspecified
RI4403290001Medicare NSC