Provider Demographics
NPI:1487620928
Name:JARAMILLO, ANA M
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:M
Last Name:JARAMILLO
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 1:6939 YELLOWSTONE BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3795
Mailing Address - Country:US
Mailing Address - Phone:718-575-3300
Mailing Address - Fax:347-644-5759
Practice Address - Street 1:6939 YELLOWSTONE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3795
Practice Address - Country:US
Practice Address - Phone:718-575-3300
Practice Address - Fax:347-644-5759
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192768207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01755288Medicaid
NY4989DZMedicare ID - Type Unspecified
NY01755288Medicaid