Provider Demographics
NPI:1568686426
Name:FONTANILLA, ELI NEBRES (PT)
Entity Type:Individual
Prefix:MR
First Name:ELI
Middle Name:NEBRES
Last Name:FONTANILLA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BRIGHTON 8TH PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6364
Mailing Address - Country:US
Mailing Address - Phone:718-769-0678
Mailing Address - Fax:
Practice Address - Street 1:152 MADISON AVE
Practice Address - Street 2:SUITE 1700
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5424
Practice Address - Country:US
Practice Address - Phone:212-889-6540
Practice Address - Fax:212-889-4987
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY26786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist