Provider Demographics
NPI:1306216338
Name:ESPELETA, BENIGNO (PT)
Entity Type:Individual
Prefix:
First Name:BENIGNO
Middle Name:
Last Name:ESPELETA
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 1:817 E 180TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-1305
Mailing Address - Country:US
Mailing Address - Phone:845-505-3579
Mailing Address - Fax:
Practice Address - Street 1:817 E 180TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-1305
Practice Address - Country:US
Practice Address - Phone:845-505-3579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist