Provider Demographics
NPI:1023273240
Name:FELIX, NEMESIO CRUZ JR (PT)
Entity type:Individual
Prefix:
First Name:NEMESIO
Middle Name:CRUZ
Last Name:FELIX
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:FELIX
Other - Middle Name:NEMESIO
Other - Last Name:CRUZ
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:4870 HYLAN BOULEVARD
Mailing Address - Street 2:SOUTH SHORE SI PHYSICAL THERAPY
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312
Mailing Address - Country:US
Mailing Address - Phone:718-227-0198
Mailing Address - Fax:718-948-0772
Practice Address - Street 1:4870 HYLAN BOULEVARD
Practice Address - Street 2:SOUTH SHORE SI PHYSICAL THERAPY
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312
Practice Address - Country:US
Practice Address - Phone:718-227-0198
Practice Address - Fax:718-948-0772
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016967-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist