Healthcare Provider Details

I. General information

NPI: 1205991908
Provider Name (Legal Business Name): RICHARD FRED STORCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/25/2006
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 BLOOMINGDALE RD
WHITE PLAINS NY
10605-1504
US

IV. Provider business mailing address

21 BLOOMINGDALE RD
WHITE PLAINS NY
10605-1504
US

V. Phone/Fax

Practice location:
  • Phone: 914-997-5965
  • Fax: 914-997-5770
Mailing address:
  • Phone: 914-997-5965
  • Fax: 914-997-5770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number172130
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number172130
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: