Provider Demographics
NPI:1720099096
Name:CAMARGO, MARIELLA (CNM)
Entity Type:Individual
Prefix:
First Name:MARIELLA
Middle Name:
Last Name:CAMARGO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SKYLINE DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2147
Mailing Address - Country:US
Mailing Address - Phone:914-467-7343
Mailing Address - Fax:914-418-1042
Practice Address - Street 1:4 SKYLINE DR
Practice Address - Street 2:SUITE 7
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2147
Practice Address - Country:US
Practice Address - Phone:914-467-7343
Practice Address - Fax:914-418-1042
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000312176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01855687Medicaid
NY01855687Medicaid