Healthcare Provider Details

I. General information

NPI: 1629652755
Provider Name (Legal Business Name): MARIA DANIELA JARRIN JARA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 10/20/2026
Certification Date: 10/20/2026
Deactivation Date: 04/28/2022
Reactivation Date: 02/27/2024

III. Provider practice location address

1400 PELHAM PARKWAY SOUTH
BRONX NY
10461
US

IV. Provider business mailing address

1400 PELHAM PARKWAY SOUTH
BRONX NY
10461
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-5642
  • Fax: 718-918-3174
Mailing address:
  • Phone: 718-918-5642
  • Fax: 718-918-3174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number342685
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: