Provider Demographics
NPI:1083975908
Name:SARMIENTO, ROXANA I (BIL SPECIAL EDMS)
Entity Type:Individual
Prefix:
First Name:ROXANA
Middle Name:I
Last Name:SARMIENTO
Suffix:
Gender:F
Credentials:BIL SPECIAL EDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2257 ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-5105
Mailing Address - Country:US
Mailing Address - Phone:917-673-4221
Mailing Address - Fax:
Practice Address - Street 1:2257 ELLIS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-5105
Practice Address - Country:US
Practice Address - Phone:917-673-4221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist