Provider Demographics
NPI:1346242120
Name:FRESNEDA, CARIDAD I (MD)
Entity Type:Individual
Prefix:
First Name:CARIDAD
Middle Name:I
Last Name:FRESNEDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-4221
Mailing Address - Country:US
Mailing Address - Phone:914-237-8282
Mailing Address - Fax:914-237-8575
Practice Address - Street 1:30 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-4221
Practice Address - Country:US
Practice Address - Phone:914-237-8282
Practice Address - Fax:914-237-8575
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY319254OtherWELLCARE (NEW YORK) #
NY3C7286OtherHEALTHNET#
NY5413A1OtherEMPIRE BC/BS (YONKERS)
NYWP733OtherOXFORD#
190207OtherHIP#
NY239874OtherWELLCARE (YONKERS) #
NY4126116OtherTACONIC#
NY4126116OtherMVP#
NY01389486Medicaid
NY5413A2OtherEMPIRE BC/BS (NEW YORK)
NY5996376OtherGHI PPO
NYP00292042OtherRAILROAD MDCR #
NY0453253OtherAETNA #
NY000000088706OtherGHI HMO #
NY004086OtherCONNECTICARE #
NY5413A1OtherEMPIRE BC/BS (YONKERS)
NY004086OtherCONNECTICARE #