1578295309 NPI number — VANESSA VERONICA ORDONEZ VILLACRES

Table of content: VANESSA VERONICA ORDONEZ VILLACRES (NPI 1578295309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578295309 NPI number — VANESSA VERONICA ORDONEZ VILLACRES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORDONEZ VILLACRES
Provider First Name:
VANESSA
Provider Middle Name:
VERONICA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1578295309
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
760 BROADWAY
Provider Second Line Business Mailing Address:
DEPARTMENT OF PEDIATRICS, ROOM 6B23
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-963-7956
Provider Business Mailing Address Fax Number:
718-963-7957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
760 BROADWAY
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PEDIATRICS, ROOM 6B23
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-963-7956
Provider Business Practice Location Address Fax Number:
718-963-7957
Provider Enumeration Date:
06/29/2022

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: 390200000X , 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)





Copyright © 2007-2024 www.npivalidator.com