Basic Information
| Provider Information | |||||||||
| NPI: | 1063564177 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLALIA | ||||||||
| FirstName: | SONNY | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Credential: | BSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8829 54TH AVE | ||||||||
| Address2: | APT 1 | ||||||||
| City: | ELMHURST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113734543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187602312 | ||||||||
| FaxNumber: | 7187602312 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 SHEFFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112072420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183452273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 024152-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.