Provider Demographics
NPI:1760622930
Name:SOLIVEN, ANIELEN FERNANDEZ (PT)
Entity Type:Individual
Prefix:
First Name:ANIELEN
Middle Name:FERNANDEZ
Last Name:SOLIVEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANIELEN
Other - Middle Name:FERNANDEZ
Other - Last Name:SOBREMISANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:128 MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-2345
Mailing Address - Country:US
Mailing Address - Phone:347-613-0849
Mailing Address - Fax:718-727-3305
Practice Address - Street 1:128 MAINE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-2345
Practice Address - Country:US
Practice Address - Phone:347-613-0849
Practice Address - Fax:718-727-3305
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010063225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist