Provider Demographics
NPI:1437494994
Name:ALTIDOR, MAGALIE (CNA)
Entity Type:Individual
Prefix:
First Name:MAGALIE
Middle Name:
Last Name:ALTIDOR
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S 29TH ST
Mailing Address - Street 2:
Mailing Address - City:WYANDANCH
Mailing Address - State:NY
Mailing Address - Zip Code:11798-2705
Mailing Address - Country:US
Mailing Address - Phone:631-643-0560
Mailing Address - Fax:
Practice Address - Street 1:122 S 29TH ST
Practice Address - Street 2:
Practice Address - City:WYANDANCH
Practice Address - State:NY
Practice Address - Zip Code:11798-2705
Practice Address - Country:US
Practice Address - Phone:631-643-0560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330311880490E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide