1851308068 NPI number — CRAIG M RICHTER MD

Table of content: CRAIG M RICHTER MD (NPI 1851308068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851308068 NPI number — CRAIG M RICHTER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHTER
Provider First Name:
CRAIG
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851308068
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
148 EAST MAIN ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-265-8780
Provider Business Mailing Address Fax Number:
631-257-5097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
148 EAST MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-265-8780
Provider Business Practice Location Address Fax Number:
631-257-5097
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  198407 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 113640866 . This is a "NORTHSHORE LIJ IPA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3382050006 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5021720 . This is a "AET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0499025 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 198407-A72 . This is a "HEALTHFIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 402B01 . This is a "BLUECROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 58876P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 89909 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 175106 . This is a "UHC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 198407S . This is a "HEALTHCARE PARTNERS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01717615 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2716256 . This is a "AET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4C0328 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P687110 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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