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Individual

CANDIDA CORDICE-FORD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
11120 MERRICK BLVD, ST ALBANS, NY 11433
(718) 206-9888
(718) 206-3033
Mailing address
80 MARCUS DR, PROVIDER ENROLLMENT, MELVILLE, NY 11747-4230
(631) 391-7889
(631) 454-4163

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
213753
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01991542
NY
Enumeration date
05/11/2006
Last updated
01/15/2014
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