1942441837 NPI number — MRS. MARY JANE FERNANDEZ VILCHEZ PT

Table of content: MRS. MARY JANE FERNANDEZ VILCHEZ PT (NPI 1942441837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942441837 NPI number — MRS. MARY JANE FERNANDEZ VILCHEZ PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VILCHEZ
Provider First Name:
MARY JANE
Provider Middle Name:
FERNANDEZ
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1942441837
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9059 55TH AVE APT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELMHURST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11373-4560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-681-5812
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14436 87TH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIARWOOD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11435-3124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
929-478-0660
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2009

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: 225100000X , with the licence number:  030162 , 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)





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