Healthcare Provider Details

I. General information

NPI: 1003725839
Provider Name (Legal Business Name): MIGUEL S RIASCOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 STRYKER LN
CLINTON NY
13323-1213
US

IV. Provider business mailing address

1 STRYKER LN
CLINTON NY
13323-1213
US

V. Phone/Fax

Practice location:
  • Phone: 646-954-1463
  • Fax:
Mailing address:
  • Phone: 646-954-1463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: