Provider Demographics
NPI:1750537056
Name:HERITAGE PODIATRY INC.
Entity type:Organization
Organization Name:HERITAGE PODIATRY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:RICCITELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:401-567-9288
Mailing Address - Street 1:PO BOX 731
Mailing Address - Street 2:
Mailing Address - City:CHEPACHET
Mailing Address - State:RI
Mailing Address - Zip Code:02814-0997
Mailing Address - Country:US
Mailing Address - Phone:401-567-9288
Mailing Address - Fax:
Practice Address - Street 1:5 MONEY HILL RD
Practice Address - Street 2:
Practice Address - City:CHEPACHET
Practice Address - State:RI
Practice Address - Zip Code:02814-1304
Practice Address - Country:US
Practice Address - Phone:401-567-9288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center