Healthcare Provider Details

I. General information

NPI: 1821766171
Provider Name (Legal Business Name): MS. CARMELLE VIERGE CHROIRILUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243-34 MAYDA RD
ROSEDALE NY
11422
US

IV. Provider business mailing address

243-34 MAYDA RD
ROSEDALE NY
11422
US

V. Phone/Fax

Practice location:
  • Phone: 718-123-4566
  • Fax:
Mailing address:
  • Phone: 516-424-5665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1427305201
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: