Healthcare Provider Details

I. General information

NPI: 1447354592
Provider Name (Legal Business Name): JUAN DEL RIO MARTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 EAST 98TH STREET 14TH FL
NEW YORK NY
10029-6574
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL BOX 1263
NEW YORK NY
10029-6574
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-0623
  • Fax: 212-241-6238
Mailing address:
  • Phone: 212-241-0623
  • Fax: 212-241-6238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number002659
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: