Healthcare Provider Details

I. General information

NPI: 1801870894
Provider Name (Legal Business Name): RICHMOND ORTHOPAEDIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 RALPH PLACE ROOM 102
SI NY
10304
US

IV. Provider business mailing address

11 RALPH PLACE ROOM 102
SI NY
10304
US

V. Phone/Fax

Practice location:
  • Phone: 718-447-6545
  • Fax: 718-447-5297
Mailing address:
  • Phone: 718-447-6545
  • Fax: 718-447-5297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number217494
License Number StateNY

VIII. Authorized Official

Name: MR. KRISHNE URS
Title or Position: PRESIDENT
Credential: MD
Phone: 718-447-6545