Basic Information
| Provider Information | |||||||||
| NPI: | 1306498696 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARZU | ||||||||
| FirstName: | ANA | ||||||||
| MiddleName: | LYDIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9114 MERRICK BLVD FL 6 | ||||||||
| Address2: | |||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114325363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182628190 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9114 MERRICK BLVD FL 6 | ||||||||
| Address2: | |||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114325363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182628190 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2019 | ||||||||
| LastUpdateDate: | 07/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | NY | N | Other Service Providers | Specialist | 246Y00000X | NY | N | Technologists, Technicians & Other Technical Service Providers | Spec/Tech, Health Info | 171M00000X | NY | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.