Provider Demographics
NPI:1003823584
Name:CORDERO, EVELYN (MD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:
Last Name:CORDERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 CASTLE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-1344
Mailing Address - Country:US
Mailing Address - Phone:718-792-3117
Mailing Address - Fax:718-792-0979
Practice Address - Street 1:941 CASTLE HILL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-1344
Practice Address - Country:US
Practice Address - Phone:718-792-3117
Practice Address - Fax:718-792-0979
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146024207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00790547Medicaid
NY00790547Medicaid
NY40F621Medicare ID - Type Unspecified