Basic Information
| Provider Information | |||||||||
| NPI: | 1023453107 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NOYOLA | ||||||||
| FirstName: | ESTELA | ||||||||
| MiddleName: | DE LOS ANGELES | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 259 FIRST STREET | ||||||||
| Address2: | DEPARTMENT OF PEDIATRICS | ||||||||
| City: | MINEOLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166632288 | ||||||||
| FaxNumber: | 5166638955 | ||||||||
| Practice Location | |||||||||
| Address1: | 259 1ST ST DEPT OF | ||||||||
| Address2: | |||||||||
| City: | MINEOLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115013957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166632288 | ||||||||
| FaxNumber: | 5166638955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2013 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 284391 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.