Healthcare Provider Details

I. General information

NPI: 1730540600
Provider Name (Legal Business Name): RICHMOND ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 HYLAN BLVD
STATEN ISLAND NY
10305-1922
US

IV. Provider business mailing address

1360 HYLAN BLVD
STATEN ISLAND NY
10305-1922
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-3577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KENNETH CHAPMAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 718-667-3577