Healthcare Provider Details

I. General information

NPI: 1841745338
Provider Name (Legal Business Name): RICHMOND MEDICAL PRACTICE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2066 RICHMOND AVE STE 202
STATEN ISLAND NY
10314-3961
US

IV. Provider business mailing address

PO BOX 4234
WARREN NJ
07059-0234
US

V. Phone/Fax

Practice location:
  • Phone: 973-903-0434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ANURAG BHATIA
Title or Position: MD
Credential:
Phone: 973-903-0434