Provider Demographics
NPI:1760979009
Name:TERRADO-ESTIRA QUALITY CARE PRACTICE INC
Entity Type:Organization
Organization Name:TERRADO-ESTIRA QUALITY CARE PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:BAUTISTA
Authorized Official - Last Name:TERRADO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:646-799-6569
Mailing Address - Street 1:1150 PELHAM PKWY S APT 4G
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1034
Mailing Address - Country:US
Mailing Address - Phone:646-799-6569
Mailing Address - Fax:570-729-7242
Practice Address - Street 1:120 BENCHLEY PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-3402
Practice Address - Country:US
Practice Address - Phone:347-843-7760
Practice Address - Fax:570-729-7242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04285558Medicaid