Basic Information
| Provider Information | |||||||||
| NPI: | 1154836856 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALTAZAR | ||||||||
| FirstName: | MARIA NERISA | ||||||||
| MiddleName: | MAGBOJOS | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MAGBOJOS | ||||||||
| OtherFirstName: | MARIA NERISA | ||||||||
| OtherMiddleName: | CARINGAL | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6120 WOODSIDE AVE APT 2V | ||||||||
| Address2: | |||||||||
| City: | WOODSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113773522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9292506634 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 32 UNION SQ E | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100033209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126773989 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2017 | ||||||||
| LastUpdateDate: | 12/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 040501 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.