Provider Demographics
NPI:1053668053
Name:PEDRON, ANDREA FRANCHESCA PANGANIBAN (PT)
Entity Type:Individual
Prefix:
First Name:ANDREA FRANCHESCA
Middle Name:PANGANIBAN
Last Name:PEDRON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14040 QUEENS BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-3220
Mailing Address - Country:US
Mailing Address - Phone:718-480-6794
Mailing Address - Fax:718-480-6985
Practice Address - Street 1:14040 QUEENS BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-3220
Practice Address - Country:US
Practice Address - Phone:718-480-6794
Practice Address - Fax:718-480-6985
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034779225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist