Provider Demographics
NPI:1750315438
Name:RITTER, RICHARD ADAM (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ADAM
Last Name:RITTER
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 1:285 SILLS RD BLDG 18
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4808
Mailing Address - Country:US
Mailing Address - Phone:631-475-1224
Mailing Address - Fax:631-475-1588
Practice Address - Street 1:285 SILLS RD BLDG 18
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4808
Practice Address - Country:US
Practice Address - Phone:631-475-1224
Practice Address - Fax:631-475-1588
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198240207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02101600Medicaid
NYG99267Medicare UPIN
NY02101600Medicaid