1003360835 NPI number — MRS. MARITZA CARDONA MA BILINGUAL SPE. ED

Table of content: MRS. MARITZA CARDONA MA BILINGUAL SPE. ED (NPI 1003360835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003360835 NPI number — MRS. MARITZA CARDONA MA BILINGUAL SPE. ED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARDONA
Provider First Name:
MARITZA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA BILINGUAL SPE. ED
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARDONA
Provider Other First Name:
MARITZA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA BILINGUAL SPE. ED
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1003360835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
590 E 166TH ST
Provider Second Line Business Mailing Address:
APT 2J
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10456-5615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-490-7963
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
590 E 166TH ST
Provider Second Line Business Practice Location Address:
APT 2J
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10456-5615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-490-7963
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2016

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" .

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

  • Identifier: SPECIALIST 174400000 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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