Basic Information
| Provider Information | |||||||||
| NPI: | 1942849401 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CESTARO | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | CHARLES | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 MERCER PL | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103083430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185644387 | ||||||||
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| Practice Location | |||||||||
| Address1: | 65 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100062503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125146499 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2020 | ||||||||
| LastUpdateDate: | 01/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 045099 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.