Provider Demographics
NPI:1922732809
Name:JUARIO, CHARMAINE IRISH LONGAKIT (PT)
Entity Type:Individual
Prefix:
First Name:CHARMAINE IRISH
Middle Name:LONGAKIT
Last Name:JUARIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702
Mailing Address - Country:US
Mailing Address - Phone:217-610-0058
Mailing Address - Fax:
Practice Address - Street 1:1345 AVENUE OF THE AMERICAS
Practice Address - Street 2:11TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10105
Practice Address - Country:US
Practice Address - Phone:212-981-1977
Practice Address - Fax:646-786-4026
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041321225100000X
IL070023561225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC236Medicaid
568946544OtherBCBS
5874OtherHEALTH PARTNERS