Provider Demographics
NPI:1730174111
Name:NAZARIO, RODOLFO A (MD)
Entity type:Individual
Prefix:MR
First Name:RODOLFO
Middle Name:A
Last Name:NAZARIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3006
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-0466
Mailing Address - Country:US
Mailing Address - Phone:845-343-6461
Mailing Address - Fax:845-343-7613
Practice Address - Street 1:129 WICKHAM AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-3714
Practice Address - Country:US
Practice Address - Phone:845-343-6461
Practice Address - Fax:845-343-7613
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY191800208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01642319Medicaid
NY01642319Medicaid
D08763Medicare UPIN