Healthcare Provider Details

I. General information

NPI: 1942389010
Provider Name (Legal Business Name): RICHARD DRANITZKE, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 BELLE TERRE RD
PORT JEFFERSON NY
11777-1935
US

IV. Provider business mailing address

635 BELLE TERRE RD
PORT JEFFERSON NY
11777-1935
US

V. Phone/Fax

Practice location:
  • Phone: 631-473-1602
  • Fax:
Mailing address:
  • Phone: 631-473-1602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number099574
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD DRANITZKE
Title or Position: MD
Credential: MD
Phone: 631-473-1602