MEDICARE: DR. RICHARD T GORECKI D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	000072	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518964691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD T GORECKI D.P.M.

Provider Business Mailing Address
First Line	:	PO BOX 138
Second Line	:
City	:	MADISON
State	:	CT
Zip	:	06443-0138
Country	:	US
Telephone Number	:	203-245-9202
Fax Number	:

Provider Business Practice Location Address
First Line	:	1353 BOSTON POST RD
Second Line	:	STE 6
City	:	MADISON
State	:	CT
Zip	:	06443-3403
Country	:	US
Telephone Number	:	203-245-9202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	12/05/2007

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