Healthcare Provider Details

I. General information

NPI: 1538073739
Provider Name (Legal Business Name): INTRODUCTION BEFORE YOU BEGIN, MAKE SURE YOU HAVE THE FOLLOWING INFORMATION: THIS INFORMATION WILL B
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9405 35TH AVE APT D10
JACKSON HEIGHTS NY
11372-6079
US

IV. Provider business mailing address

9405 35TH AVE APT D10
JACKSON HEIGHTS NY
11372-6079
US

V. Phone/Fax

Practice location:
  • Phone: 917-832-0546
  • Fax:
Mailing address:
  • Phone: 917-832-0546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: CESAR AMADO MARTE RODRIGUEZ
Title or Position: MANAGING MEMBER
Credential:
Phone: 917-832-0546