Provider Demographics
NPI:1306421193
Name:CARDENAS, JOHN MANUEL (RN)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MANUEL
Last Name:CARDENAS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 CRESCENT ST FL 2
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2838
Mailing Address - Country:US
Mailing Address - Phone:347-998-3134
Mailing Address - Fax:
Practice Address - Street 1:2419 CRESCENT ST FL 2
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2838
Practice Address - Country:US
Practice Address - Phone:347-998-3134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY768319163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse