Healthcare Provider Details

I. General information

NPI: 1104403245
Provider Name (Legal Business Name): RAPHAEL J RIOS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 06/17/2023
Certification Date: 06/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 MADISON AVE
NEW YORK NY
10029-6508
US

IV. Provider business mailing address

150 50TH AVE APT 1102
LONG ISLAND CITY NY
11101-6076
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6500
  • Fax:
Mailing address:
  • Phone: 347-738-7108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number812129
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: