Healthcare Provider Details

I. General information

NPI: 1780188896
Provider Name (Legal Business Name): RAFAEL SAMUEL CARDONA RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 BLOOMINGDALE RD FL 2
WHITE PLAINS NY
10605-1513
US

IV. Provider business mailing address

660 WHITE PLAINS RD STE 400
TARRYTOWN NY
10591-5107
US

V. Phone/Fax

Practice location:
  • Phone: 914-949-3888
  • Fax: 914-949-1271
Mailing address:
  • Phone: 914-984-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number25MA11788000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number64001
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number322215
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: