Provider Demographics
NPI:1689888125
Name:DUSTAMANTE ORDENIZA, MARIE CARMEL (RPT)
Entity Type:Individual
Prefix:
First Name:MARIE CARMEL
Middle Name:
Last Name:DUSTAMANTE ORDENIZA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3871 SEDGWICK AVE APT 1B
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4433
Mailing Address - Country:US
Mailing Address - Phone:718-548-1212
Mailing Address - Fax:718-548-1900
Practice Address - Street 1:3166 BAINBRIDGE AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-3922
Practice Address - Country:US
Practice Address - Phone:718-548-1212
Practice Address - Fax:718-548-1900
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2008-09-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY0269312251C2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonary