Healthcare Provider Details

I. General information

NPI: 1588927123
Provider Name (Legal Business Name): MR. RICHARD LLANOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 E 62ND ST
NEW YORK NY
10065-8206
US

IV. Provider business mailing address

2565 MARION AVE
BRONX NY
10458-4716
US

V. Phone/Fax

Practice location:
  • Phone: 212-289-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: