Provider Demographics
NPI:1538286364
Name:ESTRADA, JOSE JEYWARD PALMA V
Entity Type:Individual
Prefix:MR
First Name:JOSE JEYWARD
Middle Name:PALMA
Last Name:ESTRADA
Suffix:V
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 1:15011 72ND RD
Mailing Address - Street 2:STUDIO C
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2150
Mailing Address - Country:US
Mailing Address - Phone:718-526-6376
Mailing Address - Fax:718-526-6376
Practice Address - Street 1:15011 72ND RD
Practice Address - Street 2:STUDIO C
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2150
Practice Address - Country:US
Practice Address - Phone:718-526-6376
Practice Address - Fax:718-526-6376
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist