1235837147 NPI number — WYATT AUSTIN RICHTER

Table of content: WYATT AUSTIN RICHTER (NPI 1235837147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235837147 NPI number — WYATT AUSTIN RICHTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHTER
Provider First Name:
WYATT
Provider Middle Name:
AUSTIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1235837147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SUNY AT STONY BROOK, DEPARTMENT OF HOSPITAL DENTISTRY
Provider Second Line Business Mailing Address:
WESTCHESTER HALL, ROOM 151
Provider Business Mailing Address City Name:
STONY BROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11794-8711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-444-2557
Provider Business Mailing Address Fax Number:
631-444-6013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
680 S COUNTRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST PATCHOGUE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11772-5551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-475-1191
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2023

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: 122300000X , with the licence number:  064164 , 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)





Copyright © 2007-2025 www.npivalidator.com