Provider Demographics
NPI:1386670925
Name:PRINCIPE, APOLONIO AGUILERA JR (PT)
Entity Type:Individual
Prefix:
First Name:APOLONIO
Middle Name:AGUILERA
Last Name:PRINCIPE
Suffix:JR
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 1:26 FIREMENS MEMORIAL DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3553
Mailing Address - Country:US
Mailing Address - Phone:800-750-8616
Mailing Address - Fax:845-362-8400
Practice Address - Street 1:1075 CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-3242
Practice Address - Country:US
Practice Address - Phone:800-750-8616
Practice Address - Fax:845-362-8474
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY024321-1OtherNY LICENSE