Provider Demographics
NPI:1225407927
Name:LINDO, MAGELENA
Entity Type:Individual
Prefix:
First Name:MAGELENA
Middle Name:
Last Name:LINDO
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 1:3472 KINGSLAND AVE
Mailing Address - Street 2:PRIVATE HOUSE
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-1604
Mailing Address - Country:US
Mailing Address - Phone:718-757-0053
Mailing Address - Fax:
Practice Address - Street 1:3472 KINGSLAND AVE
Practice Address - Street 2:PRIVATE HOUSE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-1604
Practice Address - Country:US
Practice Address - Phone:718-757-0053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist