Provider Demographics
NPI:1356659676
Name:VICOY, DOREEN PANGANDOYON
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:PANGANDOYON
Last Name:VICOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 VAN COURTLAND AVE
Mailing Address - Street 2:EAST #6D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467
Mailing Address - Country:US
Mailing Address - Phone:212-481-8678
Mailing Address - Fax:212-481-6398
Practice Address - Street 1:277 VAN CORTLANDT AVE E
Practice Address - Street 2:EAST #6D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-3011
Practice Address - Country:US
Practice Address - Phone:212-481-8678
Practice Address - Fax:212-481-6398
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024507225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist