Basic Information
| Provider Information | |||||||||
| NPI: | 1770663791 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2524 ROUTE 9W | ||||||||
| Address2: | |||||||||
| City: | RAVENA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187567390 | ||||||||
| FaxNumber: | 5187568030 | ||||||||
| Practice Location | |||||||||
| Address1: | 2524 ROUTE 9W | ||||||||
| Address2: | |||||||||
| City: | RAVENA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187567390 | ||||||||
| FaxNumber: | 5187568030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 12/14/2007 | ||||||||
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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 | 207Q00000X | 182990 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000494454005 | 01 | NY | BSNENY | OTHER | 7299168 | 01 | NY | AETNA | OTHER | 01410282 | 05 | NY | MEDICAID | 10031231 | 01 | NY | CDPHP | OTHER | 200299 | 01 | NY | SENIOR WHOLE HEALTH | OTHER | 5538P1 | 01 | NY | EMPIRE BC | OTHER | 071030000106 | 01 | NY | FIDELIS | OTHER | 119672 | 01 | NY | GHI/HMO | OTHER | 08340 | 01 | NY | MVP | OTHER |