Provider Demographics
NPI:1619931623
Name:BIONDI, RICHARD NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:NICHOLAS
Last Name:BIONDI
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 1:1 POMPERAUG OFFICE PARK
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2295
Mailing Address - Country:US
Mailing Address - Phone:203-264-3130
Mailing Address - Fax:203-264-3129
Practice Address - Street 1:1 POMPERAUG OFFICE PARK
Practice Address - Street 2:SUITE 202
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2295
Practice Address - Country:US
Practice Address - Phone:203-264-3130
Practice Address - Fax:203-264-3129
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT015280207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB83826Medicare UPIN
CT290000024Medicare ID - Type Unspecified