Provider Demographics
NPI:1700819869
Name:NEVIN, MARISTELA S (PT)
Entity Type:Individual
Prefix:MS
First Name:MARISTELA
Middle Name:S
Last Name:NEVIN
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:PO BOX 4720
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-8720
Mailing Address - Country:US
Mailing Address - Phone:845-294-3484
Mailing Address - Fax:
Practice Address - Street 1:78 CYPRESS RD STE 4
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6815
Practice Address - Country:US
Practice Address - Phone:845-294-3484
Practice Address - Fax:845-294-3483
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023613-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY202134565Other1199 NATIONAL BENEFIT FUN
NY10067538OtherCDPHP
NY832412OtherMANAGED PHYSICAL NETWORK
NY603436OtherMVP
NY1000028553OtherAFFINITY
NY1356066001OtherCIGNA
NY202134565OtherBEECHSTREET
NY202134565OtherMULTIPLAN
NY207622OtherWELLCARE
NY58662OtherGHI (HMO)
NY6696813OtherGHI (PPO)
NY90177OtherLOCAL 825 WELFARE PLAN
NYQ18H01OtherBCBS
NY202134565OtherMAGNACARE
NY202134565OtherPOMCO
NY207622OtherWELLCARE