MEDICARE: CLAUDIA RIOS-DATTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	239516-1	NY

General Provider Information

NPI Number	:	1366493074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAUDIA RIOS-DATTA MD

Provider Business Mailing Address
First Line	:	635 E 14TH ST
Second Line	:	APT 1A
City	:	NEW YORK
State	:	NY
Zip	:	10009-3228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1577 HONE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1505
Country	:	US
Telephone Number	:	718-863-0500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	07/08/2007

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