Provider Demographics
NPI:1568441913
Name:DE LA HOZ, RAFAEL E (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:E
Last Name:DE LA HOZ
Suffix:
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 1:1 GUSTAVE L LEVY PL
Mailing Address - Street 2:BOX 1059
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6500
Mailing Address - Country:US
Mailing Address - Phone:212-241-7996
Mailing Address - Fax:212-241-5516
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:ANNENBERG 3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6500
Practice Address - Country:US
Practice Address - Phone:212-241-8080
Practice Address - Fax:212-241-5516
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194493174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4C6004OtherHEALTHNET
NY2512681OtherGHI
NY6V958OtherEMPIRE BLUE CROSS/BLUE SHIELD
NY7585207OtherAETNA PPO/POS
NY2078882OtherUNITED HEALTHCARE
NY01825007Medicaid
NY194493-NO3OtherHIP
NY2078882OtherUNITED HEALTHCARE
NY01825007Medicaid