Healthcare Provider Details

I. General information

NPI: 1205876018
Provider Name (Legal Business Name): RICHARD ROUDER, DPM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 RICHMOND AVE
STATEN ISLAND NY
10314-3912
US

IV. Provider business mailing address

1855 RICHMOND AVE
STATEN ISLAND NY
10314-3912
US

V. Phone/Fax

Practice location:
  • Phone: 718-556-5550
  • Fax: 718-556-7868
Mailing address:
  • Phone: 718-556-5550
  • Fax: 718-556-7868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN005371
License Number StateNY

VIII. Authorized Official

Name: DR. RICHARD ROUDER
Title or Position: PRESIDENT
Credential: DPM
Phone: 718-556-5550