Healthcare Provider Details

I. General information

NPI: 1407837990
Provider Name (Legal Business Name): RICHARD A ALTWERGER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 COLUMBIA TPKE SUITE102
CASTLETON NY
12033-9584
US

IV. Provider business mailing address

1528 COLUMBIA TPKE SUITE102
CASTLETON NY
12033-9584
US

V. Phone/Fax

Practice location:
  • Phone: 518-479-3338
  • Fax: 518-479-3358
Mailing address:
  • Phone: 518-479-3338
  • Fax: 518-479-3358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN0031701
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: