Healthcare Provider Details

I. General information

NPI: 1992752703
Provider Name (Legal Business Name): RICHARD P KASKIW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 W EMBARGO ST
ROME NY
13440-5138
US

IV. Provider business mailing address

PO BOX 340
NEW HARTFORD NY
13413-0340
US

V. Phone/Fax

Practice location:
  • Phone: 315-337-3391
  • Fax: 315-337-0515
Mailing address:
  • Phone: 315-732-9368
  • Fax: 315-732-9403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number184549-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: