Provider Demographics
NPI:1629724513
Name:BANDES DURAN, PEDRO EFRAIN
Entity Type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:EFRAIN
Last Name:BANDES DURAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 BRADHURST AVE APT 7V
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-3316
Mailing Address - Country:US
Mailing Address - Phone:407-978-4429
Mailing Address - Fax:
Practice Address - Street 1:68 BRADHURST AVE APT 7V
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-3316
Practice Address - Country:US
Practice Address - Phone:407-978-4429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator