Basic Information
| Provider Information | |||||||||
| NPI: | 1821004698 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGUIRRE | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 67 KENDALL ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CLIFTON SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144329701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154629482 | ||||||||
| FaxNumber: | 3154625438 | ||||||||
| Practice Location | |||||||||
| Address1: | 5989 BIG TREE RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LAKEVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144809719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853464460 | ||||||||
| FaxNumber: | 5853464463 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 08/27/2007 | ||||||||
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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 | 213119 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02068546 | 05 | NY | MEDICAID |