Provider Demographics
NPI:1952950768
Name:RICHARDSON, TITO P
Entity Type:Individual
Prefix:
First Name:TITO
Middle Name:P
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8684 208TH ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-1651
Mailing Address - Country:US
Mailing Address - Phone:702-355-3791
Mailing Address - Fax:
Practice Address - Street 1:8684 208TH ST APT 1B
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-1651
Practice Address - Country:US
Practice Address - Phone:702-355-3791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi