Provider Demographics
NPI:1568477081
Name:BUENCONSEJO, MARY ELAINE E (PT)
Entity Type:Individual
Prefix:MISS
First Name:MARY ELAINE
Middle Name:E
Last Name:BUENCONSEJO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15 PARK ROW
Mailing Address - Street 2:#15J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-2301
Mailing Address - Country:US
Mailing Address - Phone:212-571-4800
Mailing Address - Fax:
Practice Address - Street 1:111 JOHN ST
Practice Address - Street 2:SUITE 1445
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-3101
Practice Address - Country:US
Practice Address - Phone:212-571-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023922-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ12X23Medicare ID - Type Unspecified