Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Rene S Mediavillo, MD

Individual provider Specialist · NPI 1376622019

Dr. Rene S Mediavillo, MD is a Radiation Oncology in Ozone Park, New York. Qualified in 1973, 53 years ago. Accepts Medicare assignment. Licensed in New York.

Years since qualifying
53
Licensed in
NY
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

9202 Liberty Ave
Ozone Park, NY 11417-1526
Phone: (718) 835-9729
Fax: (718) 925-9817
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X · Licence 136585 (NY)

Record details

NPI number1376622019
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedNovember 3, 2006
Last updated in NPPESJuly 9, 2007

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyRADIATION ONCOLOGY
Medical schoolOTHER
Graduated 1973 (53 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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