Provider Demographics
NPI:1538105374
Name:DIVINAGRACIA, CID RAMOS
Entity Type:Individual
Prefix:MR
First Name:CID
Middle Name:RAMOS
Last Name:DIVINAGRACIA
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 1:610 W 150TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-2433
Mailing Address - Country:US
Mailing Address - Phone:212-281-4400
Mailing Address - Fax:212-281-4600
Practice Address - Street 1:610 W 150TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-2433
Practice Address - Country:US
Practice Address - Phone:212-281-4400
Practice Address - Fax:212-281-4600
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ18K21Medicare ID - Type Unspecified