Provider Demographics
NPI:1679661664
Name:PITCH, RICHARD JAY (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAY
Last Name:PITCH
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 1:1739 N OCEAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-2683
Mailing Address - Country:US
Mailing Address - Phone:631-714-4100
Mailing Address - Fax:631-714-4191
Practice Address - Street 1:1739 N OCEAN AVE STE A
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-2683
Practice Address - Country:US
Practice Address - Phone:631-714-4100
Practice Address - Fax:631-714-4191
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1917652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY83-0357375OtherTAX ID NUMBER
NY94F692Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER