Provider Demographics
NPI:1043572621
Name:PIEDRAHITA, ELSA VICTORIA
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:VICTORIA
Last Name:PIEDRAHITA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8383 118TH ST
Mailing Address - Street 2:APT 2 L
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2442
Mailing Address - Country:US
Mailing Address - Phone:718-779-8800
Mailing Address - Fax:718-779-2070
Practice Address - Street 1:8383 118TH ST
Practice Address - Street 2:APT 2 L
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-2442
Practice Address - Country:US
Practice Address - Phone:718-779-8800
Practice Address - Fax:718-779-2070
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator