Provider Demographics
NPI:1437348323
Name:CENIZA, DRAZEN VINCENT (PT)
Entity Type:Individual
Prefix:
First Name:DRAZEN
Middle Name:VINCENT
Last Name:CENIZA
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 1:4420 FRANCIS LEWIS BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3041
Mailing Address - Country:US
Mailing Address - Phone:718-438-9369
Mailing Address - Fax:718-423-9825
Practice Address - Street 1:4420 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3041
Practice Address - Country:US
Practice Address - Phone:718-438-9369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030904225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03103073Medicaid
NY1437348323OtherNPI