Healthcare Provider Details

I. General information

NPI: 1023294279
Provider Name (Legal Business Name): RICHARD J. RICHTER, PODIATRIST, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 ROSE ST
SAG HARBOR NY
11963-3001
US

IV. Provider business mailing address

PO BOX 537
SAG HARBOR NY
11963-0024
US

V. Phone/Fax

Practice location:
  • Phone: 631-725-0555
  • Fax: 631-899-3264
Mailing address:
  • Phone: 631-725-0555
  • Fax: 631-899-3264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD JAY RICHTER
Title or Position: OWNER/PODIATRIST
Credential: D,P.M.
Phone: 631-725-0555