Healthcare Provider Details

I. General information

NPI: 1477616001
Provider Name (Legal Business Name): RICHARD MAROTTO DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 ANNANDALE RD
STONY BROOK NY
11790-2405
US

IV. Provider business mailing address

5 ANNANDALE RD
STONY BROOK NY
11790-2405
US

V. Phone/Fax

Practice location:
  • Phone: 631-475-3900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberN005101
License Number StateNY

VIII. Authorized Official

Name: RICHARD MAROTTO
Title or Position: SOLE PROPRIETOR
Credential:
Phone: 631-475-3900