1295172500 NPI number — MRS. CYNTHIA ENRIQUEZ DESEPEDA MD EARLY CHILDHOOD

Table of content: MRS. CYNTHIA ENRIQUEZ DESEPEDA MD EARLY CHILDHOOD (NPI 1295172500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295172500 NPI number — MRS. CYNTHIA ENRIQUEZ DESEPEDA MD EARLY CHILDHOOD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DESEPEDA
Provider First Name:
CYNTHIA
Provider Middle Name:
ENRIQUEZ
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD EARLY CHILDHOOD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295172500
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5764 MAZEAU ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASPETH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11378-1927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-224-5516
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9777 QUEENS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REGO PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11374-3335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-830-9274
Provider Business Practice Location Address Fax Number:
718-830-0761
Provider Enumeration Date:
05/28/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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