Provider Demographics
NPI:1043586399
Name:PAREDES, JASMINE PATRICIA (BS)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:PATRICIA
Last Name:PAREDES
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 W 47TH ST
Mailing Address - Street 2:APT.# 3R
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-2345
Mailing Address - Country:US
Mailing Address - Phone:917-907-3211
Mailing Address - Fax:
Practice Address - Street 1:2580 AMSTERDAM AVE
Practice Address - Street 2:ROOM 408
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-3461
Practice Address - Country:US
Practice Address - Phone:212-927-8303
Practice Address - Fax:212-928-7733
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06 0227542251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics