Provider Demographics
NPI:1619190956
Name:CANTOR, RICHARD IRA (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:IRA
Last Name:CANTOR
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 1:680 ROUTE 211 E
Mailing Address - Street 2:STE 3B-187
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-1757
Mailing Address - Country:US
Mailing Address - Phone:917-848-0559
Mailing Address - Fax:
Practice Address - Street 1:680 ROUTE 211 E
Practice Address - Street 2:STE 3B-187
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-1757
Practice Address - Country:US
Practice Address - Phone:917-848-0559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109606207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAC3333820OtherDEA
NYAC3333820OtherDEA