Individual
RICHARD BATE OCTAVIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
2811 QUEENS PLZ N, LONG ISLAND CITY, NY 11101-4172
(718) 391-8300
Mailing address
52-68, 68TH STREET, MASPETH, NY 11378
(910) 527-6945
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
610001
NY
Other
Enumeration date
09/23/2020
Last updated
09/23/2020
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