Provider Demographics
NPI:1023294279
Name:RICHARD J. RICHTER, PODIATRIST, P.C
Entity type:Organization
Organization Name:RICHARD J. RICHTER, PODIATRIST, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:D,PM
Authorized Official - Phone:631-725-0555
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:631-899-3264
Practice Address - Street 1:12 ROSE ST
Practice Address - Street 2:
Practice Address - City:SAG HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11963-3001
Practice Address - Country:US
Practice Address - Phone:631-725-0555
Practice Address - Fax:631-899-3264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0608990001Medicare NSC