Healthcare Provider Details

I. General information

NPI: 1508353780
Provider Name (Legal Business Name): CRISTINA ROCHA CARIDI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 GRAND ST
BROOKLYN NY
11211-4802
US

IV. Provider business mailing address

1407 W 6TH ST
BROOKLYN NY
11204-4802
US

V. Phone/Fax

Practice location:
  • Phone: 212-226-7666
  • Fax: 212-202-7988
Mailing address:
  • Phone: 718-256-1057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number311227
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: