=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912052044
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD HAMBURG MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2007
-----------------------------------------------------
Last Update Date | 07/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 257 MIDDLE COUNTRY RD
-----------------------------------------------------
City | SMITHTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-251-8103
-----------------------------------------------------
Fax | 631-724-5275
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 257 MIDDLE COUNTRY RD
-----------------------------------------------------
City | SMITHTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-251-8103
-----------------------------------------------------
Fax | 631-724-5275
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | DOMENICA LAGUARDIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 631-724-4664
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------