Healthcare Provider Details

I. General information

NPI: 1245483643
Provider Name (Legal Business Name): MS. HILDA E MARES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HILDA E CHUSID

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 MADISON AVE
NEW YORK NY
10017-1110
US

IV. Provider business mailing address

6910 108TH ST
FOREST HILLS NY
11375-3800
US

V. Phone/Fax

Practice location:
  • Phone: 212-418-0323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: