Healthcare Provider Details

I. General information

NPI: 1740260298
Provider Name (Legal Business Name): ELISE C. RICHTOL DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 PARTRIDGE LN
WATERFORD NY
12188-1091
US

IV. Provider business mailing address

3 PARTRIDGE LN
WATERFORD NY
12188-1091
US

V. Phone/Fax

Practice location:
  • Phone: 518-233-1188
  • Fax: 518-233-1188
Mailing address:
  • Phone: 518-233-1188
  • Fax: 518-233-1188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN004804
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: