Provider Demographics
NPI:1003209164
Name:MARIA CAMPO INC
Entity type:Organization
Organization Name:MARIA CAMPO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CELESTE
Authorized Official - Last Name:CAMPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-435-1789
Mailing Address - Street 1:5917 69TH PL
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-2926
Mailing Address - Country:US
Mailing Address - Phone:917-435-1789
Mailing Address - Fax:
Practice Address - Street 1:5917 69TH PL
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-2926
Practice Address - Country:US
Practice Address - Phone:917-435-1789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency