Healthcare Provider Details

I. General information

NPI: 1093482077
Provider Name (Legal Business Name): RAPHAEL ANDRES RIVERA-CRUZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUNY DOWNSTATE MEDICAL CENTER 450 CLARKSON AVENUE
BROOKLYN NY
11203
US

IV. Provider business mailing address

SUNY DOWNSTATE MEDICAL CENTER 450 CLARKSON AVENUE
BROOKLYN NY
11203
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-8867
  • Fax:
Mailing address:
  • Phone: 718-270-8867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME184469
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: