Provider Demographics
NPI:1023199049
Name:MALDONADO, EDNA DEBORAH (OTR, CHT)
Entity Type:Individual
Prefix:MRS
First Name:EDNA
Middle Name:DEBORAH
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 STONELEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3931
Mailing Address - Country:US
Mailing Address - Phone:845-279-1111
Mailing Address - Fax:
Practice Address - Street 1:686 STONELEIGH AVE
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-3923
Practice Address - Country:US
Practice Address - Phone:845-279-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006402174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY421589939OtherCIGNA
NYP00431088OtherRAILROAD MEDICARE
NY2247511OtherUNITED HEALTH CARE
NYQS8831OtherEMPIRE BLUE CROSS BLUE SH
NY421589939OtherCIGNA
NY4909390001Medicare NSC