Provider Demographics
NPI:1922361617
Name:UBALDO, EFIGENIA AMES (MS SPECIAL EDUCATI)
Entity Type:Individual
Prefix:
First Name:EFIGENIA
Middle Name:AMES
Last Name:UBALDO
Suffix:
Gender:F
Credentials:MS SPECIAL EDUCATI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 BROUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4216
Mailing Address - Country:US
Mailing Address - Phone:718-406-1823
Mailing Address - Fax:973-771-1356
Practice Address - Street 1:515 BROUGHTON AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-4216
Practice Address - Country:US
Practice Address - Phone:718-406-1823
Practice Address - Fax:973-771-1356
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY792106971174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist