1588900591 NPI number — ERIC RISHE MD

Table of content: (NPI 1588900591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588900591 NPI number — ERIC RISHE MD

Organization/Personal Information

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

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:
1588900591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 W 38TH STREET
Provider Second Line Business Mailing Address:
SUITE 306
Provider Business Mailing Address City Name:
NEW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10018-0121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9205 ROOSEVELT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON HEIGHTS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11372-7941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-612-4676
Provider Business Practice Location Address Fax Number:
347-612-4160
Provider Enumeration Date:
12/19/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RISHE
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
917-570-6945

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  2334921 , 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)