Basic Information
| Provider Information | |||||||||
| NPI: | 1700100336 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUENASEDA | ||||||||
| FirstName: | ERWIN | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1265 WAYNE AVE STE 308 | ||||||||
| Address2: | 119 PROFESSIONAL BUILDING | ||||||||
| City: | INDIANA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 157013501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7240818095 | ||||||||
| FaxNumber: | 7248018147 | ||||||||
| Practice Location | |||||||||
| Address1: | 2701 KIRKWOOD HWY | ||||||||
| Address2: | LOWER LEVEL | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198054911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026681768 | ||||||||
| FaxNumber: | 3026681794 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2010 | ||||||||
| LastUpdateDate: | 07/23/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | JI-0001072 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 2449064 | 05 | MD | MEDICAID | 2155101 | 01 | DE | HIGHMARK | OTHER | 3775507000 | 01 | DE | IBC | OTHER | P01033496 | 01 | DE | MEDIARE RR | OTHER | 1700100336 | 05 | DE | MEDICAID |