Provider Demographics
NPI:1922031558
Name:DY TIOCO, ELMER SANTOS (PT)
Entity Type:Individual
Prefix:MR
First Name:ELMER
Middle Name:SANTOS
Last Name:DY TIOCO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-3523
Mailing Address - Country:US
Mailing Address - Phone:646-209-2055
Mailing Address - Fax:201-338-2177
Practice Address - Street 1:600 S LIVINGSTON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5419
Practice Address - Country:US
Practice Address - Phone:800-530-3247
Practice Address - Fax:973-740-9007
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist