Provider Demographics
NPI:1073038204
Name:BIAG, SYDNEY LEXTER N (RPT)
Entity Type:Individual
Prefix:
First Name:SYDNEY LEXTER
Middle Name:N
Last Name:BIAG
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10003 PMB 1341
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950
Mailing Address - Country:US
Mailing Address - Phone:670-233-4646
Mailing Address - Fax:670-233-4648
Practice Address - Street 1:MARIANAS HEALTH LLC BLDG STE 102
Practice Address - Street 2:GHIYEGHI ST. SAN JOSE
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950-8903
Practice Address - Country:US
Practice Address - Phone:670-233-4646
Practice Address - Fax:670-233-4646
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP0047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY032545OtherNEW YORK LICENSE
MP0047OtherNORTHERN MARIANA LICENSE