Healthcare Provider Details

I. General information

NPI: 1154807683
Provider Name (Legal Business Name): CAROLYN OCHOA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 YORK AVE
NEW YORK NY
10065-4805
US

IV. Provider business mailing address

11 CORBIN AVE
JERSEY CITY NJ
07306-5601
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-3027
  • Fax:
Mailing address:
  • Phone: 201-360-9915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number306471-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: