Provider Demographics
NPI:1417326067
Name:DOLIGON, IRSAM YAPE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:IRSAM
Middle Name:YAPE
Last Name:DOLIGON
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E 198TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458
Mailing Address - Country:US
Mailing Address - Phone:347-270-9243
Mailing Address - Fax:347-270-8244
Practice Address - Street 1:245 E 198TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458
Practice Address - Country:US
Practice Address - Phone:347-270-9243
Practice Address - Fax:347-270-8244
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047656225100000X
NY009363225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist