Provider Demographics
NPI:1164912994
Name:IGNISKA, ADELA CRISTINA (MS, ATC)
Entity Type:Individual
Prefix:
First Name:ADELA
Middle Name:CRISTINA
Last Name:IGNISKA
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 MARCH DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1841
Mailing Address - Country:US
Mailing Address - Phone:718-612-4642
Mailing Address - Fax:
Practice Address - Street 1:24 SAW MILL RIVER RD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-1541
Practice Address - Country:US
Practice Address - Phone:914-631-6969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0015762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
080702200OtherBOC ATC