Provider Demographics
NPI:1609042985
Name:LUSAN-URENA, MARY GRACE ABONETS (PT)
Entity Type:Individual
Prefix:
First Name:MARY GRACE
Middle Name:ABONETS
Last Name:LUSAN-URENA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARY GRACE
Other - Middle Name:ABONETS
Other - Last Name:LUSAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 360
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-0360
Mailing Address - Country:US
Mailing Address - Phone:516-374-6838
Mailing Address - Fax:516-374-2362
Practice Address - Street 1:125 FRANKLIN AVE
Practice Address - Street 2:ISLAND MUSCULOSKELETAL CARE, MD,PC
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2165
Practice Address - Country:US
Practice Address - Phone:516-887-1787
Practice Address - Fax:516-887-2059
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023781225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400058526Medicare PIN
NYG400131854Medicare PIN
NYA400100804Medicare PIN
NYQ54842L091Medicare PIN
NYQ54842L092Medicare PIN
NYQ54842L093Medicare PIN