Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 146024 | NY |
NPI | 1003823584 |
---|---|
Provider Name | Dr. Evelyn Cordero |
First Address | Bronx, NY 10473-1344 |
Second Address | Bronx, NY 10473-1344 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00790547 | (05) | NY |
C04484 | (02) | NY |