Basic Information
| Provider Information | |||||||||
| NPI: | 1952931255 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PASTOR | ||||||||
| FirstName: | JOYCE MARY REGINA | ||||||||
| MiddleName: | HIPOL | ||||||||
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| Credential: | PT, DPT CANDIDATE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1938 82ND ST APT C1 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112142339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3473270325 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 50 SHEFFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112072420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183452273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2020 | ||||||||
| LastUpdateDate: | 01/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 038718 | NY | N | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 225100000X | 038718 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.