Provider Demographics
NPI:1003360835
Name:CARDONA, MARITZA (MA BILINGUAL SPE ED)
Entity Type:Individual
Prefix:MRS
First Name:MARITZA
Middle Name:
Last Name:CARDONA
Suffix:
Gender:F
Credentials:MA BILINGUAL SPE ED
Other - Prefix:MRS
Other - First Name:MARITZA
Other - Middle Name:
Other - Last Name:CARDONA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA BILINGUAL SPE ED
Mailing Address - Street 1:590 E 166TH ST
Mailing Address - Street 2:APT 2J
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-5615
Mailing Address - Country:US
Mailing Address - Phone:347-490-7963
Mailing Address - Fax:
Practice Address - Street 1:590 E 166TH ST
Practice Address - Street 2:APT 2J
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-5615
Practice Address - Country:US
Practice Address - Phone:347-490-7963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYSPECIALIST 174400000Medicaid