Provider Demographics
NPI:1376856401
Name:MACASERO, JENNIFER ABUEVA
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ABUEVA
Last Name:MACASERO
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 1:3234 60TH ST # 2F
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2028
Mailing Address - Country:US
Mailing Address - Phone:646-645-5158
Mailing Address - Fax:
Practice Address - Street 1:3234 60TH ST # 2F
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2028
Practice Address - Country:US
Practice Address - Phone:646-645-5158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-18
Last Update Date:2010-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029859-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics