Basic Information
| Provider Information | |||||||||
| NPI: | 1477967065 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLAUDIO | ||||||||
| FirstName: | OKYRO | ||||||||
| MiddleName: | CANDELARIA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | COLLAZO | ||||||||
| OtherFirstName: | OKYRO | ||||||||
| OtherMiddleName: | CANDELARIA | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | D.O. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 14 LUCILLE LN | ||||||||
| Address2: | |||||||||
| City: | DIX HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117465810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185514738 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 175 FULTON AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | HEMPSTEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115503702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162921034 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2014 | ||||||||
| LastUpdateDate: | 11/10/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 287301 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.