1972938256 NPI number — MS. WENDY VIMARY PORRATA LMSW

Table of content: MS. WENDY VIMARY PORRATA LMSW (NPI 1972938256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972938256 NPI number — MS. WENDY VIMARY PORRATA LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PORRATA
Provider First Name:
WENDY
Provider Middle Name:
VIMARY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
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:
1972938256
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2842 RANDALL AVE FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10465-2410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-770-3224
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4123 THIRD AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-299-3045
Provider Business Practice Location Address Fax Number:
718-716-2604
Provider Enumeration Date:
09/05/2013

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: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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