Provider Demographics
NPI:1477096527
Name:LIZARDO ORBE, EDWINA ODETTE
Entity Type:Individual
Prefix:
First Name:EDWINA
Middle Name:ODETTE
Last Name:LIZARDO ORBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EDWINA
Other - Middle Name:
Other - Last Name:ADRIEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1 OLD BRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2332
Mailing Address - Country:US
Mailing Address - Phone:917-647-6750
Mailing Address - Fax:
Practice Address - Street 1:120 E 56TH ST
Practice Address - Street 2:SUITE 1010
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3607
Practice Address - Country:US
Practice Address - Phone:212-759-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-22
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62 021026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist