Healthcare Provider Details

I. General information

NPI: 1083975064
Provider Name (Legal Business Name): CAROLA E CENTENO B.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1301 5TH AVE NORTHSIDE CENTER FOR CHILD DEVELOPMENT
NEW YORK NY
10029-3119
US

IV. Provider business mailing address

1301 5TH AVE NORTHSIDE CENTER FOR CHILD DEVELOPMENT
NEW YORK NY
10029-3119
US

V. Phone/Fax

Practice location:
  • Phone: 212-426-3400
  • Fax: 212-426-8976
Mailing address:
  • Phone: 212-426-3400
  • Fax: 212-426-8976

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: