Provider Demographics
NPI:1538219605
Name:DELACRUZ-GOMEZ, RAFAEL ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:ANTONIO
Last Name:DELACRUZ-GOMEZ
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 1:1570 MCDONALD ST
Mailing Address - Street 2:APT 2 B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2208
Mailing Address - Country:US
Mailing Address - Phone:347-685-5391
Mailing Address - Fax:
Practice Address - Street 1:1085 PARK AVE OFC 1E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1180
Practice Address - Country:US
Practice Address - Phone:212-360-7760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185160207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY96F971Medicare ID - Type Unspecified
NYE96157Medicare UPIN