Provider Demographics
NPI:1053575225
Name:RICHMOND INTERNAL MEDICINE GROUP, P.C.
Entity type:Organization
Organization Name:RICHMOND INTERNAL MEDICINE GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:N
Authorized Official - Last Name:CHACON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-448-6800
Mailing Address - Street 1:800 MANOR RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-7034
Mailing Address - Country:US
Mailing Address - Phone:718-448-6800
Mailing Address - Fax:718-448-9458
Practice Address - Street 1:800 MANOR RD
Practice Address - Street 2:SUITE 4
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7034
Practice Address - Country:US
Practice Address - Phone:718-448-6800
Practice Address - Fax:718-448-9458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ3W9T1Medicare PIN