Provider Demographics
NPI:1326251539
Name:BAGUNU, MARY JANE GUNAYON (PYSICAL THERAPIST)
Entity Type:Individual
Prefix:MISS
First Name:MARY JANE
Middle Name:GUNAYON
Last Name:BAGUNU
Suffix:
Gender:F
Credentials:PYSICAL THERAPIST
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Mailing Address - Street 1:4160 MAIN ST
Mailing Address - Street 2:STE 201B
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3899
Mailing Address - Country:US
Mailing Address - Phone:718-886-6696
Mailing Address - Fax:718-886-9686
Practice Address - Street 1:4606 79TH ST FL 2
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3536
Practice Address - Country:US
Practice Address - Phone:917-605-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY026645225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02731542Medicaid