Basic Information
| Provider Information | |||||||||
| NPI: | 1043238181 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 119 LAWRENCE STREET | ||||||||
| Address2: | |||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185847361 | ||||||||
| FaxNumber: | 5185847930 | ||||||||
| Practice Location | |||||||||
| Address1: | 119 LAWRENCE ST | ||||||||
| Address2: | |||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128661346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185847361 | ||||||||
| FaxNumber: | 5185847930 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 09/25/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0000X | N004241-1 | NY | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 141824381 | 01 | NY | TAX ID# | OTHER | 03189519 | 05 | NY | MEDICAID |