Provider Demographics
NPI:1497117758
Name:ROSADO-RIVERA, DWINDALLY (MD, EDD, MSC)
Entity Type:Individual
Prefix:
First Name:DWINDALLY
Middle Name:
Last Name:ROSADO-RIVERA
Suffix:
Gender:F
Credentials:MD, EDD, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WORTH ST RM 402
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 WORTH ST RM 402
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3050
Practice Address - Country:US
Practice Address - Phone:646-962-3400
Practice Address - Fax:646-962-0130
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY301334207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program