Provider Demographics
NPI:1871987693
Name:RICHE, BERTHONY
Entity type:Individual
Prefix:MR
First Name:BERTHONY
Middle Name:
Last Name:RICHE
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 1:2322 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3169
Mailing Address - Country:US
Mailing Address - Phone:516-719-0761
Mailing Address - Fax:516-719-0762
Practice Address - Street 1:2322 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3169
Practice Address - Country:US
Practice Address - Phone:516-433-1239
Practice Address - Fax:516-719-0762
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 372500000X, 372600000X, 374K00000X, 374U00000X, 376J00000X, 376K00000X
NY2704L001374U00000X
NY3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No251E00000XAgenciesHome Health
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide