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General NPI Number Information
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NPI Number | 1043104763
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Entity Type | Individual
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Provider Name | MRS. LISSETTE ESTEFANIA SILVA
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Gender | Female
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 465 GRAND STREET FLOOR 2
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City | NEW YORK
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State | NY
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Zip | 10002-4800
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Country | US
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Telephone | 212-420-1999
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Fax |
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Provider Business Mailing Address
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Address Line | 1891 STOCKHOLM ST
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City | RIDGEWOOD
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State | NY
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Zip | 11385-1349
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 737849823
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License Number State | NY
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