Provider Demographics
NPI:1821213448
Name:PICHARDO, FEDERICO ANTONIO SR (PHYSICIAN ASS)
Entity Type:Individual
Prefix:MR
First Name:FEDERICO
Middle Name:ANTONIO
Last Name:PICHARDO
Suffix:SR
Gender:M
Credentials:PHYSICIAN ASS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:511 W 189 ST
Mailing Address - Street 2:APT 5F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040
Mailing Address - Country:US
Mailing Address - Phone:212-568-0326
Mailing Address - Fax:
Practice Address - Street 1:435 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3506
Practice Address - Country:US
Practice Address - Phone:212-923-0408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2015-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02102858Medicaid
NY02102858Medicaid