MEDICARE: RYE FAMILY PRACTICE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1578770459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RYE FAMILY PRACTICE PC

Provider Business Mailing Address
First Line	:	692 W 204TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10034-3027
Country	:	US
Telephone Number	:	646-329-6490
Fax Number	:

Provider Business Practice Location Address
First Line	:	692 W 204TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10034-3027
Country	:	US
Telephone Number	:	646-329-6490
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT SAMANIEGO
Credential	:
Telephone Number	:	718-930-7030

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	06/04/2020

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