Provider Demographics
NPI:1629172705
Name:ORDWAY, RICHARD JOHN JR (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOHN
Last Name:ORDWAY
Suffix:JR
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 HAWK DR
Mailing Address - Street 2:STUDENT HEALTH SERVICE, SUNY NEW PALTZ
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-2447
Mailing Address - Country:US
Mailing Address - Phone:845-257-3400
Mailing Address - Fax:845-257-3415
Practice Address - Street 1:1 HAWK DR
Practice Address - Street 2:STUDENT HEALTH SERVICE, SUNY NEW PALTZ
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-2447
Practice Address - Country:US
Practice Address - Phone:845-257-3400
Practice Address - Fax:845-257-3415
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144961207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C12015Medicare UPIN
NY71A111Medicare PIN