Provider Demographics
NPI:1932280369
Name:RICHTER, RICHARD JAY (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JAY
Last Name:RICHTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 537
Mailing Address - Street 2:
Mailing Address - City:SAG HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11963-0024
Mailing Address - Country:US
Mailing Address - Phone:631-725-0555
Mailing Address - Fax:631-725-0555
Practice Address - Street 1:12 ROSE ST
Practice Address - Street 2:
Practice Address - City:SAG HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11963-0024
Practice Address - Country:US
Practice Address - Phone:631-725-0555
Practice Address - Fax:631-725-0555
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02975213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00423143Medicaid
NY0608990001Medicare NSC
NYP32451Medicare PIN
NY00423143Medicaid