Provider Demographics
NPI:1992752703
Name:KASKIW, RICHARD P (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:P
Last Name:KASKIW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-0340
Mailing Address - Country:US
Mailing Address - Phone:315-732-9368
Mailing Address - Fax:315-732-9403
Practice Address - Street 1:122 W EMBARGO ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-5138
Practice Address - Country:US
Practice Address - Phone:315-337-3391
Practice Address - Fax:315-337-0515
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184549-1207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01258864Medicaid
NY01258864Medicaid
E98194Medicare UPIN
RA6495Medicare ID - Type Unspecified