Healthcare Provider Details

I. General information

NPI: 1124024732
Provider Name (Legal Business Name): DREW AMES RICHMAN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 ROUTE 300 STE 6
NEWBURGH NY
12550-2994
US

IV. Provider business mailing address

1418 ROUTE 300 STE 6
NEWBURGH NY
12550-2992
US

V. Phone/Fax

Practice location:
  • Phone: 845-566-6664
  • Fax: 845-566-1911
Mailing address:
  • Phone: 845-566-6664
  • Fax: 845-566-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN00 2356-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: