Provider Demographics
NPI:1770015216
Name:CYGNIFICARE PT, P.C.
Entity Type:Organization
Organization Name:CYGNIFICARE PT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEO
Authorized Official - Middle Name:MAULEON
Authorized Official - Last Name:DELA PAZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:646-416-4513
Mailing Address - Street 1:7014 136TH ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1947
Mailing Address - Country:US
Mailing Address - Phone:646-416-4513
Mailing Address - Fax:
Practice Address - Street 1:7014A 136TH ST
Practice Address - Street 2:
Practice Address - City:KEW GARDENS HILLS
Practice Address - State:NY
Practice Address - Zip Code:11367-1947
Practice Address - Country:US
Practice Address - Phone:646-416-4513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038097261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy