| Morris Heights Health Center, Inc. | |
|
85 W Burnside Ave Bronx NY 10453-4015 | |
| (718) 716-4400 | |
| Not Available |
| Full Name | Morris Heights Health Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 85 W Burnside Ave, Bronx, New York |
| Authorized Official Name and Position | Pamella Appia (MANAGER, PROVIDER ENROLLMENT & MANA) |
| Authorized Official Contact | 7184831270 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Morris Heights Health Center, Inc. 85 W Burnside Ave Bronx NY 10453-4015 Ph: (718) 483-1270 | Morris Heights Health Center, Inc. 85 W Burnside Ave Bronx NY 10453-4015 Ph: (718) 716-4400 |
| NPI Number | 1184694291 |
|---|---|
| Provider Enumeration Date | 01/23/2006 |
| Last Update Date | 04/13/2018 |
| Medicare PECOS PAC ID | 3072798172 |
|---|---|
| Medicare Enrollment ID | O20110505000508 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184694291 | NPI | - | NPPES |
| 00590390 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 7000236R (New York) | Primary |
| Provider Name | Jason Hodges |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1306828744 PECOS PAC ID: 9234033390 Enrollment ID: I20031121000082 |
| Provider Name | Stephen H Robinson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1770566580 PECOS PAC ID: 9133016686 Enrollment ID: I20040301000732 |
| Provider Name | Edmond Balakhane |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1992787121 PECOS PAC ID: 3577450717 Enrollment ID: I20040302000717 |
| Provider Name | Alexander Alerte |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275609935 PECOS PAC ID: 3971495219 Enrollment ID: I20040330000059 |
| Provider Name | Walter M Ralph |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1013983097 PECOS PAC ID: 2163416348 Enrollment ID: I20040412000549 |
| Provider Name | Nadia Marsh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811936834 PECOS PAC ID: 0345234217 Enrollment ID: I20040413001026 |
| Provider Name | Carl Guillaume |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1528098118 PECOS PAC ID: 2264421973 Enrollment ID: I20040508000059 |
| Provider Name | David I Weltman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326021163 PECOS PAC ID: 4880684687 Enrollment ID: I20040513001529 |
| Provider Name | Robert M Wilkins |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1508840505 PECOS PAC ID: 8224029459 Enrollment ID: I20040518001207 |
| Provider Name | Russell S Weinstein |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1992788459 PECOS PAC ID: 4587641261 Enrollment ID: I20040630001019 |
| Provider Name | Alfred M Fiad |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407896210 PECOS PAC ID: 7012982705 Enrollment ID: I20040826001148 |
| Provider Name | Jonathan E Lerner |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1346297645 PECOS PAC ID: 7315851904 Enrollment ID: I20041111000070 |
| Provider Name | Michael Benanti |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1619945342 PECOS PAC ID: 7911964853 Enrollment ID: I20041213000763 |
| Provider Name | Tammy R Gruenberg |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1205994324 PECOS PAC ID: 2466419197 Enrollment ID: I20041214001252 |
| Provider Name | Heidi N Kolman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881629905 PECOS PAC ID: 4486669538 Enrollment ID: I20060213000004 |
| Provider Name | Daniel R Pilosov |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013092006 PECOS PAC ID: 2466468244 Enrollment ID: I20060303000005 |
| Provider Name | Kenneth O Jones |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730139262 PECOS PAC ID: 2860409166 Enrollment ID: I20060310000637 |
| Provider Name | Assumpta A Madu |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1174604508 PECOS PAC ID: 9133224694 Enrollment ID: I20070412000255 |
| Provider Name | Marcia R. Robinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891855276 PECOS PAC ID: 7315044138 Enrollment ID: I20070512000032 |
| Provider Name | Isaac G Bampoe |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518078245 PECOS PAC ID: 6305930827 Enrollment ID: I20070914000327 |
| Provider Name | Steven I. Leffler |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326056995 PECOS PAC ID: 9436117090 Enrollment ID: I20071109000097 |
| Provider Name | Gary Kronfeld |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1063526630 PECOS PAC ID: 0042119380 Enrollment ID: I20081120000337 |
| Provider Name | Donna M Alfieri |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1457324493 PECOS PAC ID: 1052477023 Enrollment ID: I20090227000359 |
| Provider Name | Jordan Golubcow Teglasi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043479603 PECOS PAC ID: 9335296078 Enrollment ID: I20090415000060 |
| Provider Name | Emmanuel N Rodriguez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497856728 PECOS PAC ID: 9830160704 Enrollment ID: I20090609000332 |
| Provider Name | Uche O Akwuba |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992972269 PECOS PAC ID: 5597817304 Enrollment ID: I20090708000659 |
| Provider Name | Albert Chang |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1083869226 PECOS PAC ID: 4486706561 Enrollment ID: I20090721000432 |
| Provider Name | George A Zikos |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1740430941 PECOS PAC ID: 0446397152 Enrollment ID: I20091029000498 |
| Provider Name | Sara Karimi |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1356473540 PECOS PAC ID: 6709913205 Enrollment ID: I20100414000549 |
| Provider Name | Michele L Tyler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861704314 PECOS PAC ID: 3072794601 Enrollment ID: I20110302000040 |
| Provider Name | Paul O Nalieth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811017262 PECOS PAC ID: 8224212733 Enrollment ID: I20110407000483 |
| Provider Name | Luisette Cuebas |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1184697963 PECOS PAC ID: 5395920300 Enrollment ID: I20110505000785 |
| Provider Name | Sanjay Upadhyay |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538350053 PECOS PAC ID: 2668657685 Enrollment ID: I20110506000005 |
| Provider Name | N Gadie Taylor-kamara |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710122262 PECOS PAC ID: 5294910212 Enrollment ID: I20110506000022 |
| Provider Name | Jillian E Marville |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1144297417 PECOS PAC ID: 6002091030 Enrollment ID: I20110506000043 |
| Provider Name | Schevaughn M Carr Celestine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992779508 PECOS PAC ID: 2062697097 Enrollment ID: I20110506000091 |
| Provider Name | Marguerite G Bernard |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952374613 PECOS PAC ID: 8123203163 Enrollment ID: I20110506000253 |
| Provider Name | Suja Maria Sabastin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073703773 PECOS PAC ID: 3870785512 Enrollment ID: I20110624000218 |
| Provider Name | Daniel S Behin |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1386887438 PECOS PAC ID: 1557531290 Enrollment ID: I20110907000941 |
| Provider Name | Diane Traver |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962466300 PECOS PAC ID: 3870764251 Enrollment ID: I20110914000778 |
| Provider Name | Joao V Nunes Filho |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699748822 PECOS PAC ID: 8426220963 Enrollment ID: I20111006000015 |
| Provider Name | Charles Colclough |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740490796 PECOS PAC ID: 5496928947 Enrollment ID: I20111029000034 |
| Provider Name | Elaine R Swerdlow |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295794337 PECOS PAC ID: 8921271057 Enrollment ID: I20111104000293 |
| Provider Name | Sharon Pluskalowski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669487336 PECOS PAC ID: 4789858945 Enrollment ID: I20111128000366 |
| Provider Name | Armando Bernal |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1447540281 PECOS PAC ID: 8820245061 Enrollment ID: I20120823000487 |
| Provider Name | Karuna S Seidman |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1588928741 PECOS PAC ID: 1254589088 Enrollment ID: I20120919000493 |
| Provider Name | Hernan C Del Arca |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073500518 PECOS PAC ID: 0345206553 Enrollment ID: I20130821000074 |
| Provider Name | Amanda R Mondesir |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1184976672 PECOS PAC ID: 1557504545 Enrollment ID: I20130823000122 |
| Provider Name | Suresh K Nayudu |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1447427711 PECOS PAC ID: 7810113214 Enrollment ID: I20140721001246 |
| Provider Name | Aisha K Clay |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1487749685 PECOS PAC ID: 5193944890 Enrollment ID: I20140911000429 |
| Provider Name | Ebony Copeland |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548404031 PECOS PAC ID: 7214158740 Enrollment ID: I20141024001523 |
| Provider Name | Richa Garg |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1306273420 PECOS PAC ID: 8921321787 Enrollment ID: I20141231000161 |
| Provider Name | Deborah A Simmons |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1669566980 PECOS PAC ID: 9436473543 Enrollment ID: I20150121000234 |
| Provider Name | Lois Jeannine Bookhardt Murray |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609805472 PECOS PAC ID: 3375869068 Enrollment ID: I20150223001203 |
| Provider Name | Desiree Outlaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790051910 PECOS PAC ID: 1658697495 Enrollment ID: I20150313000499 |
| Provider Name | Laurie J Brucia |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1063661973 PECOS PAC ID: 2668540964 Enrollment ID: I20150317001410 |
| Provider Name | Kim Forrester Dumont |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1023336245 PECOS PAC ID: 0143549121 Enrollment ID: I20150427000247 |
| Provider Name | Akosua A Childs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700292935 PECOS PAC ID: 4082929427 Enrollment ID: I20150814012998 |
| Provider Name | Tresa S Prince |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801295373 PECOS PAC ID: 2466760400 Enrollment ID: I20150924002316 |
| Provider Name | Taina R Lopez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538562061 PECOS PAC ID: 5597074922 Enrollment ID: I20151026000355 |
| Provider Name | A Jill Leibman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1144385006 PECOS PAC ID: 6002099215 Enrollment ID: I20151117002668 |
| Provider Name | Yasmin Bahar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790161529 PECOS PAC ID: 2163722083 Enrollment ID: I20151130000007 |
| Provider Name | Andrew Wan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982049888 PECOS PAC ID: 3375846546 Enrollment ID: I20160121001142 |
| Provider Name | Dana J. Serafin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184082729 PECOS PAC ID: 6901105667 Enrollment ID: I20160502000208 |
| Provider Name | Ameeka George |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740664523 PECOS PAC ID: 3072812742 Enrollment ID: I20160502000517 |
| Provider Name | Lara Elizabeth Trevino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487046397 PECOS PAC ID: 4688963465 Enrollment ID: I20160518000571 |
| Provider Name | Rafaela M De La Huerta |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720462708 PECOS PAC ID: 2163712126 Enrollment ID: I20160602001893 |
| Provider Name | Dara Y. Herman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720449416 PECOS PAC ID: 9234422940 Enrollment ID: I20160718002134 |
| Provider Name | Michael Jae Woo Kim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578955019 PECOS PAC ID: 7214218064 Enrollment ID: I20170110001546 |
| Provider Name | Brian G Cole |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184678955 PECOS PAC ID: 5496646655 Enrollment ID: I20170112001216 |
| Provider Name | Shydu Kato |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104252527 PECOS PAC ID: 2365725025 Enrollment ID: I20170203002090 |
| Provider Name | Anastasia Gretsas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053500769 PECOS PAC ID: 1052694122 Enrollment ID: I20170215002236 |
| Provider Name | Donna Ann-marie Saunders |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275629248 PECOS PAC ID: 5991930935 Enrollment ID: I20170503001727 |
| Provider Name | Elsie A Bermudez Pouchard |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780955021 PECOS PAC ID: 3476796574 Enrollment ID: I20170503001751 |
| Provider Name | Carrie Elise Friedman |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1275985228 PECOS PAC ID: 6305117177 Enrollment ID: I20170814000321 |
| Provider Name | Simone Dos Santos Ferreira Parker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144759432 PECOS PAC ID: 3375815368 Enrollment ID: I20170825002579 |
| Provider Name | Stephanie Louise Traver |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679019384 PECOS PAC ID: 5890068175 Enrollment ID: I20170908000024 |
| Provider Name | Sasidhar Gunturu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730443870 PECOS PAC ID: 2163792854 Enrollment ID: I20170921000816 |
| Provider Name | Patrice Toni Grant |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1750738159 PECOS PAC ID: 8820362973 Enrollment ID: I20170928000197 |
| Provider Name | Brenda Luisa Brathwaite |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1427100577 PECOS PAC ID: 0345500260 Enrollment ID: I20180213003016 |
| Provider Name | Salvattore L L Portocarrero |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1164938155 PECOS PAC ID: 6507127123 Enrollment ID: I20180222002096 |
| Provider Name | Gabrielle Lisnoff |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760920979 PECOS PAC ID: 9931463148 Enrollment ID: I20180515002252 |
| Provider Name | Cavel S Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881922094 PECOS PAC ID: 7416208616 Enrollment ID: I20180927001698 |
| Provider Name | Asya Portnaya |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1144417429 PECOS PAC ID: 0143573063 Enrollment ID: I20181023002343 |
| Provider Name | Kenisha Cassandra Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710463641 PECOS PAC ID: 0345589131 Enrollment ID: I20190221001543 |
| Provider Name | Baraqat Adewole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689916389 PECOS PAC ID: 6406195007 Enrollment ID: I20190226001748 |
| Provider Name | Malba Kwabena Nanyame |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417426636 PECOS PAC ID: 9133469133 Enrollment ID: I20190328001026 |
| Provider Name | Joy C. Chris-onuoha |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801352521 PECOS PAC ID: 0345581252 Enrollment ID: I20190402002298 |
| Provider Name | Edwin Cohen Azarkian |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609290519 PECOS PAC ID: 1759683709 Enrollment ID: I20190521001119 |
| Provider Name | Toshiba E Williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912332362 PECOS PAC ID: 6901132299 Enrollment ID: I20190724002085 |
| Provider Name | Joy Adanna Ofili |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205346913 PECOS PAC ID: 9638406853 Enrollment ID: I20190812001470 |
| Provider Name | Christopher Michael Souza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568023612 PECOS PAC ID: 8729317227 Enrollment ID: I20190909002958 |
| Provider Name | Marshall Tse |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235369257 PECOS PAC ID: 6901135383 Enrollment ID: I20190910002748 |
| Provider Name | Whitney Rebecca White |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1184125551 PECOS PAC ID: 2062742083 Enrollment ID: I20190918000302 |
| Provider Name | Feonie Eleuterio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659808335 PECOS PAC ID: 1052642816 Enrollment ID: I20191008003502 |
| Provider Name | Yvonne L Figarella |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1225368939 PECOS PAC ID: 2961839733 Enrollment ID: I20200218000788 |
| Provider Name | Annette Roldan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629458500 PECOS PAC ID: 4183052574 Enrollment ID: I20200318001201 |
| Provider Name | Kaleena Danetta Clarkson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1366993081 PECOS PAC ID: 3678903614 Enrollment ID: I20200415001879 |
| Provider Name | Sandra Nathalie Martinez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750651105 PECOS PAC ID: 6800216862 Enrollment ID: I20201014000840 |
| Provider Name | Philip Boadu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992314439 PECOS PAC ID: 5294148391 Enrollment ID: I20210111000793 |
| Provider Name | Tae Kyung Lee |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1407511009 PECOS PAC ID: 6305222712 Enrollment ID: I20221007000425 |
| Provider Name | Randi Delirod |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124535026 PECOS PAC ID: 0244609543 Enrollment ID: I20221208001233 |
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