Provider Demographics
NPI:1326082801
Name:DELARA, FRANCISCO ARTURO JR (MD)
Entity Type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:ARTURO
Last Name:DELARA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 BROADWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1414
Mailing Address - Country:US
Mailing Address - Phone:212-590-2922
Mailing Address - Fax:212-590-2977
Practice Address - Street 1:604 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4859
Practice Address - Country:US
Practice Address - Phone:212-683-6200
Practice Address - Fax:212-683-2992
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1878132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01651207Medicaid
NY628761Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER ID#
NYG36029Medicare UPIN