Provider Demographics
NPI:1578870689
Name:CORDERO, JACQUELINE (DPT)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:CORDERO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6058 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-4553
Mailing Address - Country:US
Mailing Address - Phone:718-964-8246
Mailing Address - Fax:
Practice Address - Street 1:361 E 19TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2888
Practice Address - Country:US
Practice Address - Phone:212-721-5220
Practice Address - Fax:212-982-9816
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0330711225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist