Provider Demographics
NPI:1508523622
Name:ESTEBAN, ANGELITO CASDISID JR (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANGELITO
Middle Name:CASDISID
Last Name:ESTEBAN
Suffix:JR
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 E 19TH ST APT 4F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-5864
Mailing Address - Country:US
Mailing Address - Phone:347-567-3164
Mailing Address - Fax:
Practice Address - Street 1:1740 84TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-2825
Practice Address - Country:US
Practice Address - Phone:718-885-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty