Healthcare Provider Details

I. General information

NPI: 1114595014
Provider Name (Legal Business Name): CINTHYA CAROLINA AVILES RIASCOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 07/15/2024
Certification Date: 04/06/2023
Deactivation Date: 04/06/2023
Reactivation Date: 07/15/2024

III. Provider practice location address

355 BARD AVE RICHMOND UNIVERSITY MEDICAL CENTER
STATEN ISLAND NY
10310
US

IV. Provider business mailing address

355 BARD AVE RICHMOND UNIVERSITY MEDICAL CENTER
STATEN ISLAND NY
10310
US

V. Phone/Fax

Practice location:
  • Phone: 844-934-2273
  • Fax:
Mailing address:
  • Phone: 844-934-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: