Provider Demographics
NPI:1619231453
Name:FERRER, MAILEEN SUAREZ (PT)
Entity Type:Individual
Prefix:MRS
First Name:MAILEEN
Middle Name:SUAREZ
Last Name:FERRER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5354 72ND PL
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1564
Mailing Address - Country:US
Mailing Address - Phone:718-321-9688
Mailing Address - Fax:718-321-9668
Practice Address - Street 1:5354 72ND PL
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1564
Practice Address - Country:US
Practice Address - Phone:718-321-9688
Practice Address - Fax:718-321-9668
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034685174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist