Individual
MADELYN MARIE ENRIQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
705 AV X, BROOKLYN, NY 11235
(929) 312-1017
Mailing address
5410 15TH AVE, ACTIVE, BROOKLYN, NY 11219
(718) 436-0771
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NXU516631820
—
NY
Enumeration date
05/08/2021
Last updated
05/08/2021
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