Provider Demographics
NPI:1487732681
Name:CORDARO, RICHARD L (DC, CCN)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:CORDARO
Suffix:
Gender:M
Credentials:DC, CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 RICHARDSON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1023
Mailing Address - Country:US
Mailing Address - Phone:718-325-8162
Mailing Address - Fax:718-324-1685
Practice Address - Street 1:4730 RICHARDSON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1023
Practice Address - Country:US
Practice Address - Phone:718-325-8162
Practice Address - Fax:718-324-1685
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006053-1111N00000X
NY004029-1133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX46211Medicare ID - Type Unspecified
NYU10942Medicare UPIN