Provider Demographics
NPI:1760651020
Name:NERONA, EMMANUEL JOVENAL (PT)
Entity Type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:JOVENAL
Last Name:NERONA
Suffix:
Gender:M
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 234
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-0234
Mailing Address - Country:US
Mailing Address - Phone:347-701-4923
Mailing Address - Fax:914-457-4826
Practice Address - Street 1:3202 UNION ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3049
Practice Address - Country:US
Practice Address - Phone:347-701-4923
Practice Address - Fax:914-457-4826
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023460-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist