Healthcare Provider Details

I. General information

NPI: 1205379443
Provider Name (Legal Business Name): NICOLAS MARTIN HIDALGO CORRAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2016
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

100 CORPORATE DR STE 100
YONKERS NY
10701-6807
US

V. Phone/Fax

Practice location:
  • Phone: 718-741-2343
  • Fax: 718-920-4351
Mailing address:
  • Phone: 914-377-4722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number299714-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number299714-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: