Provider Demographics
NPI:1912052044
Name:RICHARD HAMBURG MD PC
Entity Type:Organization
Organization Name:RICHARD HAMBURG MD PC
Other - Org Name:BRANCH ORAL APPLIANCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOMENICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGUARDIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-724-4664
Mailing Address - Street 1:257 MIDDLE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787
Mailing Address - Country:US
Mailing Address - Phone:888-251-8103
Mailing Address - Fax:631-724-5275
Practice Address - Street 1:257 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:888-251-8103
Practice Address - Fax:631-724-5275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty