Provider Demographics
NPI:1750656021
Name:D0E
Entity Type:Organization
Organization Name:D0E
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ANDRES
Authorized Official - Last Name:DAULO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:718-429-7006
Mailing Address - Street 1:5040 JACOBUS ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3702
Mailing Address - Country:US
Mailing Address - Phone:718-429-7006
Mailing Address - Fax:718-429-6864
Practice Address - Street 1:5040 JACOBUS ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3702
Practice Address - Country:US
Practice Address - Phone:718-429-7006
Practice Address - Fax:718-429-6864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY443418-1251J00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0440065Medicaid