1669485413 NPI number — DR. MYRNA IVONNE CARDIEL M.D.

Table of content: DR. MYRNA IVONNE CARDIEL M.D. (NPI 1669485413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669485413 NPI number — DR. MYRNA IVONNE CARDIEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARDIEL
Provider First Name:
MYRNA
Provider Middle Name:
IVONNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIAZ-ORTIZ
Provider Other First Name:
MYRNA
Provider Other Middle Name:
IVONNE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669485413
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
425 WASHINGTON BLVD
Provider Second Line Business Mailing Address:
APARTMENT #2401
Provider Business Mailing Address City Name:
JERSEY CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07310-2019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-497-2979
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 1ST AVE
Provider Second Line Business Practice Location Address:
FOURTH FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016-3240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-497-2979
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2006

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: 2084N0400X , with the licence number:  243308-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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