Provider Demographics
NPI:1215178876
Name:RIOS, MARK A
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:RIOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 MATTHEWS AVE
Mailing Address - Street 2:APT A4
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-9220
Mailing Address - Country:US
Mailing Address - Phone:347-901-3991
Mailing Address - Fax:
Practice Address - Street 1:2428 MATTHEWS AVE
Practice Address - Street 2:APT A4
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-9220
Practice Address - Country:US
Practice Address - Phone:347-901-3991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007256-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY007256-1OtherCOTA