Provider Demographics
NPI:1427595909
Name:COLMENARES, RICHELLE KRISH KRISH (RPT)
Entity Type:Individual
Prefix:
First Name:RICHELLE KRISH
Middle Name:KRISH
Last Name:COLMENARES
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:RICHELLE KRISH
Other - Middle Name:SUMAOY
Other - Last Name:COLMENARES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MAIDEN NAME
Mailing Address - Street 1:101 BEACON AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306
Mailing Address - Country:US
Mailing Address - Phone:201-888-8944
Mailing Address - Fax:
Practice Address - Street 1:3744 104TH ST., CORONA
Practice Address - Street 2:
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:11368
Practice Address - Country:US
Practice Address - Phone:516-673-5466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-23
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039949225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist