Most Relevant Information
Provider Data
| NPI Number: | 1003203746 |
| Provider Name: | MARIELY VIDAL BA |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/21/2015 |
| Last Updated: | 04/21/2015 |
Provider Practice Location
16211 76TH AVE
FRESH MEADOWS
NY
113661133
Practice Location Phone/Fax
| Phone: | 9178061579 |
| Fax: |
Provider Mailing Location
16211 76TH AVE
FRESH MEADOWS
NY
113661133
Provider Mailing Phone/Fax
| Phone: | 9178061579 |
| Fax: |