Provider Demographics
NPI:1497976674
Name:BANEZ, JO NONINO SARCENO (RPT)
Entity Type:Individual
Prefix:MR
First Name:JO NONINO
Middle Name:SARCENO
Last Name:BANEZ
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7904 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2931
Mailing Address - Country:US
Mailing Address - Phone:718-894-2323
Mailing Address - Fax:718-894-5385
Practice Address - Street 1:7904 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2931
Practice Address - Country:US
Practice Address - Phone:718-894-2323
Practice Address - Fax:718-894-5385
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016152-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist