Provider Demographics
NPI:1275790545
Name:BANIQUED, JAZEL ATIENZA (PT)
Entity Type:Individual
Prefix:
First Name:JAZEL
Middle Name:ATIENZA
Last Name:BANIQUED
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8414 52ND AVE
Mailing Address - Street 2:#2
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4321
Mailing Address - Country:US
Mailing Address - Phone:347-556-2923
Mailing Address - Fax:
Practice Address - Street 1:8414 52ND AVE
Practice Address - Street 2:#2
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4321
Practice Address - Country:US
Practice Address - Phone:347-556-2923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030108-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist