Provider Demographics
NPI:1447392121
Name:CARDOSO, ERICO RAMOS (MD)
Entity Type:Individual
Prefix:DR
First Name:ERICO
Middle Name:RAMOS
Last Name:CARDOSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:249 DEGRAW ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-4440
Mailing Address - Country:US
Mailing Address - Phone:718-963-7266
Mailing Address - Fax:718-963-6491
Practice Address - Street 1:374 STOCKHOLM ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4006
Practice Address - Country:US
Practice Address - Phone:718-963-7266
Practice Address - Fax:718-963-6491
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1884131207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01360338Medicaid
NY01360338Medicaid
NYF36461Medicare UPIN