Healthcare Provider Details

I. General information

NPI: 1154737435
Provider Name (Legal Business Name): RAFAEL CIRINO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 BROADWAY FL 12
NEW YORK NY
10004-1617
US

IV. Provider business mailing address

447 BROADWAY FL 2
NEW YORK NY
10013-2562
US

V. Phone/Fax

Practice location:
  • Phone: 917-846-8542
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number677728
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number677728
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: