Provider Demographics
NPI:1598051484
Name:RICANOR, RAINIER JUDE (MD)
Entity Type:Individual
Prefix:DR
First Name:RAINIER
Middle Name:JUDE
Last Name:RICANOR
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 1:115 MAIN ST STE 305
Mailing Address - Street 2:
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-2949
Mailing Address - Country:US
Mailing Address - Phone:914-898-5565
Mailing Address - Fax:914-898-5473
Practice Address - Street 1:115 MAIN ST STE 305
Practice Address - Street 2:
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-2949
Practice Address - Country:US
Practice Address - Phone:914-898-5565
Practice Address - Fax:914-898-5473
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285337207LP2900X, 208VP0014X
390200000X
NJ25MA09680600207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology