1174907562 NPI number — GLORIA CRESPO HHA, CNA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174907562 NPI number — GLORIA CRESPO HHA, CNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRESPO
Provider First Name:
GLORIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
HHA, CNA
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:
1174907562
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6929 68TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11385-6628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-494-4132
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6929 68TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11385-6628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-494-4132
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2015

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: 171M00000X , 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: 22 . This is a "OUTPATIENT HOSPITAL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 12 . This is a "FAMILY CODE VALUE HOME" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 21 . This is a "INPATIENT HOSPITAL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 31 . This is a "SKILLED NURSING FACILITY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 99 . This is a "OTHER UNLISTED FACILITY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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