Provider Demographics
NPI:1154836856
Name:BALTAZAR, MARIA NERISA MAGBOJOS (PT)
Entity Type:Individual
Prefix:
First Name:MARIA NERISA
Middle Name:MAGBOJOS
Last Name:BALTAZAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARIA NERISA
Other - Middle Name:CARINGAL
Other - Last Name:MAGBOJOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6120 WOODSIDE AVE APT 2V
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3522
Mailing Address - Country:US
Mailing Address - Phone:929-250-6634
Mailing Address - Fax:
Practice Address - Street 1:32 UNION SQ E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3209
Practice Address - Country:US
Practice Address - Phone:212-677-3989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NY040501225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist