Healthcare Provider Details

I. General information

NPI: 1598051484
Provider Name (Legal Business Name): RAINIER JUDE RICANOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CENTEROCK RD
WEST NYACK NY
10994-2215
US

IV. Provider business mailing address

115 MAIN ST STE 305
TUCKAHOE NY
10707-2949
US

V. Phone/Fax

Practice location:
  • Phone: 845-703-6999
  • Fax: 845-703-6297
Mailing address:
  • Phone: 914-898-5565
  • Fax: 914-898-5473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number285337
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: