Provider Demographics
NPI:1902996093
Name:GIRALDO, NELSON RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:RAFAEL
Last Name:GIRALDO
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 1:10 BRENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:631-665-8007
Mailing Address - Fax:631-665-8914
Practice Address - Street 1:10 BRENTWOOD RD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-665-8007
Practice Address - Fax:631-665-8914
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175993207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0025185OtherAETNA
NY1180OtherVYTRA
NY0488131OtherCIGNA
NY142428Medicaid
NY3C9490OtherHEALTHNET
NY9657827OtherGHI
NYP431628OtherOXFORD
NY02F671OtherBLUE CROSS BLUE SHIELD
NY803853OtherFIRSTHEALTH
NY01105673Medicaid
NY0025185OtherAETNA