Provider Demographics
NPI:1114225117
Name:ESTRELLA, GERARD AGUSTIN
Entity Type:Individual
Prefix:MR
First Name:GERARD
Middle Name:AGUSTIN
Last Name:ESTRELLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8635 QUEENS BLVD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4434
Mailing Address - Country:US
Mailing Address - Phone:718-533-8588
Mailing Address - Fax:
Practice Address - Street 1:8635 QUEENS BLVD
Practice Address - Street 2:SUITE 1B
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4434
Practice Address - Country:US
Practice Address - Phone:718-533-8588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031240225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist