Provider Demographics
NPI:1497089239
Name:IGNES, SUNNY REY PACLE
Entity Type:Individual
Prefix:MR
First Name:SUNNY REY
Middle Name:PACLE
Last Name:IGNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14742 HOOVER AVE
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2140
Mailing Address - Country:US
Mailing Address - Phone:718-523-1131
Mailing Address - Fax:718-523-1131
Practice Address - Street 1:14742 HOOVER AVE
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-2140
Practice Address - Country:US
Practice Address - Phone:718-523-1131
Practice Address - Fax:718-523-1131
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-27
Last Update Date:2009-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist