Healthcare Provider Details

I. General information

NPI: 1124316393
Provider Name (Legal Business Name): RICHMOND LO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 HEMPSTEAD TURNPIKE
EAST MEADOW NY
11554
US

IV. Provider business mailing address

2201 HEMPSTEAD TURNPIKE
EAST MEADOW NY
11554
US

V. Phone/Fax

Practice location:
  • Phone: 516-486-6862
  • Fax: 516-572-5465
Mailing address:
  • Phone: 516-486-6862
  • Fax: 516-572-5465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number268568
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: