Provider Demographics
NPI:1588186126
Name:TCHICAMBOUD, ALIDA D
Entity Type:Individual
Prefix:
First Name:ALIDA
Middle Name:D
Last Name:TCHICAMBOUD
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 1:25 W 132ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-3202
Mailing Address - Country:US
Mailing Address - Phone:929-281-4466
Mailing Address - Fax:
Practice Address - Street 1:15253 10TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1216
Practice Address - Country:US
Practice Address - Phone:929-281-4466
Practice Address - Fax:929-281-4466
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-15
Last Update Date:2017-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator