Provider Demographics
NPI:1912538208
Name:VIDARTE, VERONICA EMMA
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:EMMA
Last Name:VIDARTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 SAW MILL RIVER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1047
Mailing Address - Country:US
Mailing Address - Phone:914-473-1982
Mailing Address - Fax:
Practice Address - Street 1:2 MAIN ST APT 301
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533-1542
Practice Address - Country:US
Practice Address - Phone:914-473-1982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist