Healthcare Provider Details

I. General information

NPI: 1568495414
Provider Name (Legal Business Name): RICHARD C DENISE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621A ARDEN AVE
STATEN ISLAND NY
10312-3032
US

IV. Provider business mailing address

621A ARDEN AVE
STATEN ISLAND NY
10312-3032
US

V. Phone/Fax

Practice location:
  • Phone: 917-743-3866
  • Fax: 718-365-1643
Mailing address:
  • Phone: 917-743-3866
  • Fax: 718-365-1643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number157428
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number157428
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number157428
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number157428
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number157428
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number157428
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number157428
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: