Provider Demographics
NPI:1154473411
Name:UNGARO, LYDIA FILOMENA (BSN, LPN)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:FILOMENA
Last Name:UNGARO
Suffix:
Gender:F
Credentials:BSN, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1366 MERRY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-6024
Mailing Address - Country:US
Mailing Address - Phone:917-312-1043
Mailing Address - Fax:
Practice Address - Street 1:501 SWANSON DR
Practice Address - Street 2:
Practice Address - City:THORNWOOD
Practice Address - State:NY
Practice Address - Zip Code:10594-2117
Practice Address - Country:US
Practice Address - Phone:914-769-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135267164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY135267OtherL.P.N. LICENSE
NY02291138Medicaid