Provider Demographics
NPI:1598198095
Name:LARA-DELGADO, NIEVES (MSED)
Entity Type:Individual
Prefix:
First Name:NIEVES
Middle Name:
Last Name:LARA-DELGADO
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 HIGHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3217
Mailing Address - Country:US
Mailing Address - Phone:718-926-8825
Mailing Address - Fax:
Practice Address - Street 1:293 HIGHWOOD AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3217
Practice Address - Country:US
Practice Address - Phone:718-926-8825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284674091174400000X
NY284673091174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist