Provider Demographics
NPI:1528215738
Name:BRONX DEKALB PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BRONX DEKALB PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MA.ANELYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SUAZO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-309-3163
Mailing Address - Street 1:3435 DEKALB AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2301
Mailing Address - Country:US
Mailing Address - Phone:718-547-8899
Mailing Address - Fax:
Practice Address - Street 1:3435 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2301
Practice Address - Country:US
Practice Address - Phone:718-547-8899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013814-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy