Provider Demographics
NPI:1144769472
Name:ZORRILLA, CARLOS
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:ZORRILLA
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 1:2540 30TH RD
Mailing Address - Street 2:SUITE A1
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2634
Mailing Address - Country:US
Mailing Address - Phone:646-238-3090
Mailing Address - Fax:347-396-5613
Practice Address - Street 1:2540 30TH RD
Practice Address - Street 2:SUITE A1
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2634
Practice Address - Country:US
Practice Address - Phone:646-238-3090
Practice Address - Fax:347-396-5613
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040912225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist