Provider Demographics
NPI:1760651624
Name:CARLOS, MAUREEN ANN BARLAAN
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN ANN
Middle Name:BARLAAN
Last Name:CARLOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAUREEN ANN
Other - Middle Name:GESULGA
Other - Last Name:BARLAAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:178 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4151
Mailing Address - Country:US
Mailing Address - Phone:917-605-8761
Mailing Address - Fax:
Practice Address - Street 1:178 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4151
Practice Address - Country:US
Practice Address - Phone:917-605-8761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027565225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist