Provider Demographics
NPI:1861569964
Name:ADDES, RICHARD L (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:ADDES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1739
Mailing Address - Country:US
Mailing Address - Phone:516-539-8953
Mailing Address - Fax:516-539-8912
Practice Address - Street 1:131 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-1739
Practice Address - Country:US
Practice Address - Phone:516-539-8953
Practice Address - Fax:516-539-8912
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01653965Medicaid
NY01653965Medicaid
NY35J001Medicare ID - Type Unspecified