Healthcare Provider Details

I. General information

NPI: 1568458487
Provider Name (Legal Business Name): MARIA I OLMEDA-JENKINS M.A., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY 503C
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

756 BROOK AVE C
BRONX NY
10451-4672
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-0656
  • Fax: 212-305-6142
Mailing address:
  • Phone: 718-402-0588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number001547-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: