Provider Demographics
NPI:1649217928
Name:CLAVERIA, FULGENCIO IGNACIO (PT)
Entity Type:Individual
Prefix:MR
First Name:FULGENCIO
Middle Name:IGNACIO
Last Name:CLAVERIA
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 1:8442 246TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-1725
Mailing Address - Country:US
Mailing Address - Phone:718-343-2941
Mailing Address - Fax:
Practice Address - Street 1:8442 246TH STREET
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426
Practice Address - Country:US
Practice Address - Phone:646-250-5038
Practice Address - Fax:646-250-5038
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist