Healthcare Provider Details

I. General information

NPI: 1003105164
Provider Name (Legal Business Name): NIVEA C. OCASIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5676 RIVERDALE AVE STE 202
BRONX NY
10471-2138
US

IV. Provider business mailing address

5676 RIVERDALE AVE STE 202
BRONX NY
10471-2138
US

V. Phone/Fax

Practice location:
  • Phone: 718-796-5300
  • Fax: 718-548-1161
Mailing address:
  • Phone: 718-796-5300
  • Fax: 718-548-1161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: