Provider Demographics
NPI:1093070815
Name:BANAWIS, GILRAY DIZON (RPT)
Entity Type:Individual
Prefix:MR
First Name:GILRAY
Middle Name:DIZON
Last Name:BANAWIS
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 1:45 NOLL TER
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3913
Mailing Address - Country:US
Mailing Address - Phone:718-344-6089
Mailing Address - Fax:
Practice Address - Street 1:1730 CENTRAL PARK AVE
Practice Address - Street 2:3RD FLR
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-4905
Practice Address - Country:US
Practice Address - Phone:914-337-6730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016043225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist