Provider Demographics
NPI:1407863350
Name:NAVARRO, ERICSON (PT)
Entity Type:Individual
Prefix:
First Name:ERICSON
Middle Name:
Last Name:NAVARRO
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 1:103 TERRACE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4330
Mailing Address - Country:US
Mailing Address - Phone:347-819-1531
Mailing Address - Fax:718-504-6464
Practice Address - Street 1:103 TERRACE BLVD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4330
Practice Address - Country:US
Practice Address - Phone:347-819-1531
Practice Address - Fax:718-504-6464
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11615203OtherCAQH