Provider Demographics
NPI:1689687337
Name:RICHARD ALTWERGER DPM, PC
Entity Type:Organization
Organization Name:RICHARD ALTWERGER DPM, PC
Other - Org Name:SCHODACK PODIATRY, PONDVIEW PODIATRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ALTWERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:518-479-3338
Mailing Address - Street 1:77 MILLER ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033
Mailing Address - Country:US
Mailing Address - Phone:518-479-3338
Mailing Address - Fax:518-479-3358
Practice Address - Street 1:77 MILLER ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033
Practice Address - Country:US
Practice Address - Phone:518-479-3338
Practice Address - Fax:518-479-3358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003170213E00000X
NYN003170-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52829AMedicare PIN
NY0741770001Medicare NSC