Provider Demographics
NPI:1134314297
Name:RIO A. SFERRAZZA D.O., PC
Entity Type:Organization
Organization Name:RIO A. SFERRAZZA D.O., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:SFERRAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-381-9770
Mailing Address - Street 1:6418 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-6203
Mailing Address - Country:US
Mailing Address - Phone:718-381-9770
Mailing Address - Fax:718-366-3789
Practice Address - Street 1:6418 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-6203
Practice Address - Country:US
Practice Address - Phone:718-381-9770
Practice Address - Fax:718-366-3789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0873681207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty