Provider Demographics
NPI:1548414451
Name:CUDIAMAT, NOEMI CASTILLO (PT)
Entity Type:Individual
Prefix:
First Name:NOEMI
Middle Name:CASTILLO
Last Name:CUDIAMAT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NOEMI
Other - Middle Name:DEL ROSARIO
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:22519 113TH AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2710
Mailing Address - Country:US
Mailing Address - Phone:718-791-3820
Mailing Address - Fax:
Practice Address - Street 1:22519 113TH AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-2710
Practice Address - Country:US
Practice Address - Phone:718-791-3820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020762-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist