Provider Demographics
NPI:1285199612
Name:CARDONA, JUAN (RN)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:
Last Name:CARDONA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 WYANDANCH AVE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-1921
Mailing Address - Country:US
Mailing Address - Phone:631-526-9389
Mailing Address - Fax:
Practice Address - Street 1:99 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:HAUPPAGE
Practice Address - State:NY
Practice Address - Zip Code:11788
Practice Address - Country:US
Practice Address - Phone:631-425-9694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY737429163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health