Provider Demographics
NPI:1023654696
Name:SOARES, ENEAS (RN, CCM, BSN)
Entity type:Individual
Prefix:
First Name:ENEAS
Middle Name:
Last Name:SOARES
Suffix:
Gender:M
Credentials:RN, CCM, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-3913
Mailing Address - Country:US
Mailing Address - Phone:646-660-0249
Mailing Address - Fax:
Practice Address - Street 1:871 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-3913
Practice Address - Country:US
Practice Address - Phone:646-660-0249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY747028163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty