Provider Demographics
NPI:1144211343
Name:SISON, JULEO (PT)
Entity Type:Individual
Prefix:
First Name:JULEO
Middle Name:
Last Name:SISON
Suffix:
Gender:M
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:PO BOX 360
Mailing Address - Street 2:ISLAND MUSCULOSKELETAL CARE MD PC
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-9998
Mailing Address - Country:US
Mailing Address - Phone:516-374-6838
Mailing Address - Fax:516-374-2362
Practice Address - Street 1:1512 BROADWAY
Practice Address - Street 2:ISLAND MUSCULOSKELETAL CARE MD PC
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-9998
Practice Address - Country:US
Practice Address - Phone:516-374-6838
Practice Address - Fax:516-374-2362
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q53308Medicare UPIN
NYQ25N91Medicare ID - Type Unspecified