Healthcare Provider Details

I. General information

NPI: 1700337888
Provider Name (Legal Business Name): RICHMOND MEDICAL PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2066 RICHMOND AVE SUITE 202
STATEN ISLAND NY
10314
US

IV. Provider business mailing address

2066 RICHMOND AVE SUITE 202
STATEN ISLAND NY
10314-3960
US

V. Phone/Fax

Practice location:
  • Phone: 718-698-3900
  • Fax: 855-564-5600
Mailing address:
  • Phone: 718-698-3900
  • Fax: 855-564-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number198371
License Number StateNY

VIII. Authorized Official

Name: DR. ANURAG BHATIA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 718-698-3900