Provider Demographics
NPI:1215087861
Name:RIVERA ROSADO, MIGDALIS (MD)
Entity type:Individual
Prefix:DR
First Name:MIGDALIS
Middle Name:
Last Name:RIVERA ROSADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 W 188TH ST
Mailing Address - Street 2:SUITE GFW
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-4246
Mailing Address - Country:US
Mailing Address - Phone:212-544-0440
Mailing Address - Fax:212-544-0505
Practice Address - Street 1:609 W 188TH ST
Practice Address - Street 2:SUITE GFW
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-4246
Practice Address - Country:US
Practice Address - Phone:212-544-0440
Practice Address - Fax:212-544-0505
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2426091208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI-72263Medicare UPIN