Provider Demographics
NPI:1851415830
Name:QUISPIALAYA, EVER
Entity Type:Individual
Prefix:
First Name:EVER
Middle Name:
Last Name:QUISPIALAYA
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 1:107 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-4121
Mailing Address - Country:US
Mailing Address - Phone:914-584-4892
Mailing Address - Fax:
Practice Address - Street 1:629 FIFTH AVE
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-1251
Practice Address - Country:US
Practice Address - Phone:914-738-1777
Practice Address - Fax:914-738-1772
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist