Healthcare Provider Details

I. General information

NPI: 1427120559
Provider Name (Legal Business Name): MARITZA ARCHBOLD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

392 BEDFORD PARK BLVD
BRONX NY
10458-2415
US

IV. Provider business mailing address

392 BEDFORD PARK BLVD
BRONX NY
10458-2415
US

V. Phone/Fax

Practice location:
  • Phone: 718-364-3200
  • Fax: 718-364-3200
Mailing address:
  • Phone: 718-364-3200
  • Fax: 718-364-3200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number177131-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: