Provider Demographics
NPI:1750689824
Name:GRACESQUI, ZORAIDA (HOME HEALTH RN)
Entity Type:Individual
Prefix:
First Name:ZORAIDA
Middle Name:
Last Name:GRACESQUI
Suffix:
Gender:F
Credentials:HOME HEALTH RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17A COMMODORE ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-3023
Mailing Address - Country:US
Mailing Address - Phone:518-694-9400
Mailing Address - Fax:518-694-0386
Practice Address - Street 1:17A COMMODORE ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3023
Practice Address - Country:US
Practice Address - Phone:518-694-9400
Practice Address - Fax:518-694-0386
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22485124163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY22485124OtherRN