Provider Demographics
NPI:1710529359
Name:DEL PRADO, MARTIN ANTHONY
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:ANTHONY
Last Name:DEL PRADO
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 1:4334 32ND PL PH
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-2313
Mailing Address - Country:US
Mailing Address - Phone:646-973-5439
Mailing Address - Fax:
Practice Address - Street 1:4334 32ND PL PH
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-2313
Practice Address - Country:US
Practice Address - Phone:646-973-5439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044936-012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic