MEDICARE: MR. CONRADO FALCO RAEZ

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	102L00000X	Psychoanalyst

General Provider Information

NPI Number	:	1821981135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CONRADO FALCO RAEZ

Provider Business Mailing Address
First Line	:	336 CENTRAL PARK W APT 1B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-7108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 W 86TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-4018
Country	:	US
Telephone Number	:	121-286-4366
Fax Number	:

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

Provider Enumeration Date	:	06/03/2025
Last Update Date	:	02/17/2026

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