Healthcare Provider Details

I. General information

NPI: 1366166092
Provider Name (Legal Business Name): MARIA C ARCODIA C/OGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 RENSSELAER STREET
HOOSICK FALLS NY
12090
US

IV. Provider business mailing address

32 RENSSELAER STREET
HOOSICK FALLS NY
12090
US

V. Phone/Fax

Practice location:
  • Phone: 917-548-9848
  • Fax:
Mailing address:
  • Phone: 917-548-9848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCO623
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: