Provider Demographics
NPI:1548590425
Name:SY-RANGEL, MARIA J PATRICIA (DDS)
Entity Type:Individual
Prefix:
First Name:MARIA J PATRICIA
Middle Name:
Last Name:SY-RANGEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 21ST ST
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2508
Mailing Address - Country:US
Mailing Address - Phone:516-776-8026
Mailing Address - Fax:516-933-7198
Practice Address - Street 1:8 21ST ST
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2508
Practice Address - Country:US
Practice Address - Phone:516-776-8026
Practice Address - Fax:516-933-7198
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0451271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01453025Medicaid