Provider Demographics
NPI:1992073068
Name:RICHARD MEMOLI, M.D., P.C.
Entity type:Organization
Organization Name:RICHARD MEMOLI, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:MEMOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-597-6250
Mailing Address - Street 1:3117 BUHRE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4738
Mailing Address - Country:US
Mailing Address - Phone:718-597-6250
Mailing Address - Fax:718-863-7090
Practice Address - Street 1:3117 BUHRE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4738
Practice Address - Country:US
Practice Address - Phone:718-597-6250
Practice Address - Fax:718-863-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106200261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAM4433215OtherDEA
NYAM4433215OtherDEA
NYB16212Medicare UPIN