Tiffany Crystal Altidor

Individual provider Active NPI Case Manager/Care Coordinator · Roosevelt, NY

NPI 1679281174 · NPPES record last updated Nov 14, 2022

Key facts

NPI
1679281174
Entity type
Individual (NPI type 1)
Primary specialty
Case Manager/Care Coordinator 171M00000X
Practice address
59 Gormley Ave
Roosevelt, NY 11575-2416
Phone
(516) 884-5998
NPI assigned
Nov 14, 2022
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X Yes

Addresses

Primary practice location

59 Gormley Ave
Roosevelt, NY 11575-2416

Mailing address

59 Gormley Ave
Roosevelt, NY 11575-2416
Phone (516) 884-5998

Other identifiers

IdentifierTypeStateIssuer
1194063016OtherNYEIP
256260OtherNYEIP

Electronic endpoints

TypeEndpointUseAffiliation
Other URL EIP Other

Other providers in Roosevelt, NY

All providers in Roosevelt, NY · Case Manager/Care Coordinator in New York

Sources for this page

Verify at the official NPI Registry.