Healthcare Provider Details

I. General information

NPI: 1154731578
Provider Name (Legal Business Name): MRS. ALIDA MARIA CASIMIRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 EAST 149TH STREET 2ND FLOOR
BRONX NY
10455
US

IV. Provider business mailing address

3237 RADCLIFF AVE
BRONX NY
10469
US

V. Phone/Fax

Practice location:
  • Phone: 718-485-2100
  • Fax: 718-485-2101
Mailing address:
  • Phone: 718-515-2680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number72085178
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: