Basic Information
| Provider Information | |||||||||
| NPI: | 1902000995 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DI FIORE | ||||||||
| FirstName: | RICHARD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 32 | ||||||||
| Address2: | |||||||||
| City: | NORTHBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600650032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475938460 | ||||||||
| FaxNumber: | 2242354652 | ||||||||
| Practice Location | |||||||||
| Address1: | 3033 STEINWAY ST | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188749778 | ||||||||
| FaxNumber: | 2242354652 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2007 | ||||||||
| LastUpdateDate: | 10/15/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 257864-1 | NY | N | Allopathic & Osteopathic Physicians | Family Medicine | 2086S0129X | 35.092142 | OH | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | 25MA09006600 | NJ | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | 048880 | CT | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | 257864 | NY | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 03251310 | 05 | NY | MEDICAID | 0284611 | 05 | NJ | MEDICAID | 3875795000 | 01 | NJ | AMERIHEALTH | OTHER | 8395783 | 01 | NJ | AETNA | OTHER | 0548970 | 01 | NJ | CIGNA | OTHER |