Healthcare Provider Details

I. General information

NPI: 1710550025
Provider Name (Legal Business Name): MURILO ROBERTO BASTOS SILVA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 AMSTERDAM AVE
NEW YORK NY
10025-1716
US

IV. Provider business mailing address

515 W 59TH ST APT 3A
NEW YORK NY
10019-1034
US

V. Phone/Fax

Practice location:
  • Phone: 929-407-7566
  • Fax:
Mailing address:
  • Phone: 929-407-7566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number351876
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: