MEDICARE: ADRIANA RIOS

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1801047428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIANA RIOS

Provider Business Mailing Address
First Line	:	PO BOX 940
Second Line	:
City	:	WHEATLEY HEIGHTS
State	:	NY
Zip	:	11798-0940
Country	:	US
Telephone Number	:	631-603-5595
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 MAIN AVE APT 103
Second Line	:
City	:	WHEATLEY HEIGHTS
State	:	NY
Zip	:	11798-2119
Country	:	US
Telephone Number	:	631-603-5595
Fax Number	:

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

Provider Enumeration Date	:	10/01/2008
Last Update Date	:	10/01/2008

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