Healthcare Provider Details

I. General information

NPI: 1578652400
Provider Name (Legal Business Name): HERITAGE PODIATRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MONEY HILL ROAD
CHEPACHET RI
02814
US

IV. Provider business mailing address

5 MONEY HILL ROAD PO BOX 731
CHEPACHET RI
02814
US

V. Phone/Fax

Practice location:
  • Phone: 401-567-9288
  • Fax: 401-567-7785
Mailing address:
  • Phone: 401-567-9288
  • Fax: 401-567-7785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT RICCITELLI
Title or Position: PHYSICIAN/OWNER
Credential: DPM
Phone: 401-567-9288