Provider Demographics
NPI:1194076174
Name:PICHARDO, ADALGISA (MSEDTSHH,SDA)
Entity type:Individual
Prefix:
First Name:ADALGISA
Middle Name:
Last Name:PICHARDO
Suffix:
Gender:F
Credentials:MSEDTSHH,SDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-1610
Mailing Address - Country:US
Mailing Address - Phone:917-676-8145
Mailing Address - Fax:
Practice Address - Street 1:677 PENN AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-1610
Practice Address - Country:US
Practice Address - Phone:917-676-8145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist