Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | N005101 | NY |
Y | 222Z00000X | Podiatrist | N005101 | NY |
NPI | 1003905688 |
---|---|
Provider Name | Richard Marotto JR. |
First Address | Patchogue, NY 11772-2631 |
Second Address | Patchogue, NY 11772-2631 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 04/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01453992 | (05) | NY |
A400228137 | MEDICARE (01) | |
U46314 | (02) | NY |