Provider Demographics
NPI:1922336510
Name:ESTORQUE, NIEZL HUQUERIZA
Entity Type:Individual
Prefix:MISS
First Name:NIEZL
Middle Name:HUQUERIZA
Last Name:ESTORQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E 124TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-1815
Mailing Address - Country:US
Mailing Address - Phone:212-410-8090
Mailing Address - Fax:
Practice Address - Street 1:55 E 124TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1815
Practice Address - Country:US
Practice Address - Phone:212-410-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist