Provider Demographics
NPI:1659141364
Name:DE VERA, ALAIN NICOLASORA
Entity Type:Individual
Prefix:
First Name:ALAIN
Middle Name:NICOLASORA
Last Name:DE VERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MEMORY LN APT 11
Mailing Address - Street 2:
Mailing Address - City:VALATIE
Mailing Address - State:NY
Mailing Address - Zip Code:12184-3342
Mailing Address - Country:US
Mailing Address - Phone:929-944-3055
Mailing Address - Fax:
Practice Address - Street 1:3230 CHURCH ST
Practice Address - Street 2:
Practice Address - City:VALATIE
Practice Address - State:NY
Practice Address - Zip Code:12184-2303
Practice Address - Country:US
Practice Address - Phone:518-758-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045657-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist