1205328358 NPI number — YESENIA A. ARIAS SERVICE COORDINATOR

Table of content: YESENIA A. ARIAS SERVICE COORDINATOR (NPI 1205328358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205328358 NPI number — YESENIA A. ARIAS SERVICE COORDINATOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARIAS
Provider First Name:
YESENIA
Provider Middle Name:
A.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SERVICE COORDINATOR
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:
1205328358
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 ASTOR AVE.
Provider Second Line Business Mailing Address:
SUITE 1A
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-571-2179
Provider Business Mailing Address Fax Number:
718-548-5485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 ASTOR AVE.
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-571-2179
Provider Business Practice Location Address Fax Number:
718-548-5485
Provider Enumeration Date:
06/05/2018

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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