Provider Demographics
NPI:1194219303
Name:ABAD, RAMON
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:
Last Name:ABAD
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RAMON
Other - Middle Name:
Other - Last Name:ABAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6642 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7057
Mailing Address - Country:US
Mailing Address - Phone:718-386-7000
Mailing Address - Fax:718-456-7585
Practice Address - Street 1:6642 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7057
Practice Address - Country:US
Practice Address - Phone:718-386-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
031964225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty