Provider Demographics
NPI:1225209323
Name:DEMATO, RICHARD JAMES
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JAMES
Last Name:DEMATO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3524
Mailing Address - Country:US
Mailing Address - Phone:516-379-6505
Mailing Address - Fax:
Practice Address - Street 1:552 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-2207
Practice Address - Country:US
Practice Address - Phone:631-878-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY44245183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist