Individual
MARGARITA MODESTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSED
Contact information
Practice address
3647 CORLEAR AVE, BRONX, NY 10463-2305
(718) 548-1982
Mailing address
3647 CORLEAR AVE, BRONX, NY 10463-2305
(718) 548-1982
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
171W0000X
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
97532
CPT
NY
Enumeration date
07/31/2012
Last updated
07/31/2012
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