Healthcare Provider Details

I. General information

NPI: 1194088997
Provider Name (Legal Business Name): OLGA MARINA ESPINAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 E 67TH ST
NEW YORK NY
10065-5964
US

IV. Provider business mailing address

8710 149TH AVE APT 6K
HOWARD BEACH NY
11414-1434
US

V. Phone/Fax

Practice location:
  • Phone: 212-988-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: