Healthcare Provider Details

I. General information

NPI: 1457167496
Provider Name (Legal Business Name): DAVID RIOS III ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4709 162ND ST
FLUSHING NY
11358-3642
US

IV. Provider business mailing address

4709 162ND ST
FLUSHING NY
11358-3642
US

V. Phone/Fax

Practice location:
  • Phone: 917-275-7685
  • Fax:
Mailing address:
  • Phone: 917-275-7685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: