Provider Demographics
NPI:1790468072
Name:TALAGSA, CRIS DIO LAVAREZ
Entity Type:Individual
Prefix:MR
First Name:CRIS DIO
Middle Name:LAVAREZ
Last Name:TALAGSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4898
Mailing Address - Country:US
Mailing Address - Phone:808-271-7423
Mailing Address - Fax:
Practice Address - Street 1:480 FOREST AVE
Practice Address - Street 2:
Practice Address - City:LOCUST VALLEY
Practice Address - State:NY
Practice Address - Zip Code:11560-2151
Practice Address - Country:US
Practice Address - Phone:808-271-7423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050074-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist