Provider Demographics
NPI:1205854197
Name:EPRES, BERNARD ANGELES (PT)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:ANGELES
Last Name:EPRES
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 1:8410 MAIN ST APT 144
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1724
Mailing Address - Country:US
Mailing Address - Phone:347-446-3109
Mailing Address - Fax:
Practice Address - Street 1:8410 MAIN ST APT 144
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-1724
Practice Address - Country:US
Practice Address - Phone:347-446-3109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027716225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist