Healthcare Provider Details

I. General information

NPI: 1902000995
Provider Name (Legal Business Name): RICHARD DI FIORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 STEINWAY ST
ASTORIA NY
11103
US

IV. Provider business mailing address

PO BOX 32
NORTHBROOK IL
60065-0032
US

V. Phone/Fax

Practice location:
  • Phone: 718-874-9778
  • Fax: 224-235-4652
Mailing address:
  • Phone: 847-593-8460
  • Fax: 224-235-4652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number257864-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35.092142
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25MA09006600
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number048880
License Number StateCT
# 5
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number257864
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: