Provider Demographics
NPI:1023199056
Name:TUPAZ, ALVIN NIMO (PT)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:NIMO
Last Name:TUPAZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6433 98TH ST
Mailing Address - Street 2:LL1
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3321
Mailing Address - Country:US
Mailing Address - Phone:718-544-6677
Mailing Address - Fax:718-544-6688
Practice Address - Street 1:3640 MAIN ST
Practice Address - Street 2:BASEMENT LEVEL
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6521
Practice Address - Country:US
Practice Address - Phone:718-886-4288
Practice Address - Fax:718-886-4788
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY24252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist