Provider Demographics
NPI:1881646222
Name:LERMA, GEORGINA BUENAVENTURA (RPT)
Entity Type:Individual
Prefix:MS
First Name:GEORGINA
Middle Name:BUENAVENTURA
Last Name:LERMA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MS
Other - First Name:GEORGINA
Other - Middle Name:REGINA
Other - Last Name:LERMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPT
Mailing Address - Street 1:1910 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-6027
Mailing Address - Country:US
Mailing Address - Phone:845-454-0120
Mailing Address - Fax:845-454-6080
Practice Address - Street 1:1910 SOUTH RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-6027
Practice Address - Country:US
Practice Address - Phone:845-454-0120
Practice Address - Fax:845-454-6080
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025892-1225100000X
NJ40QA01089100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400020991Medicare PIN