Provider Demographics
NPI:1639755895
Name:RIVERA, NICOUHL JAY TOLENTINO (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:NICOUHL JAY
Middle Name:TOLENTINO
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3119 33RD ST APT 1
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-2011
Mailing Address - Country:US
Mailing Address - Phone:347-453-2726
Mailing Address - Fax:845-684-0673
Practice Address - Street 1:330 W 58TH ST STE 413&407
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1827
Practice Address - Country:US
Practice Address - Phone:347-453-2726
Practice Address - Fax:845-684-0673
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist