Provider Demographics
NPI:1033932165
Name:EUCEDA, EMMANUEL ANTHONY
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:ANTHONY
Last Name:EUCEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-4547
Mailing Address - Country:US
Mailing Address - Phone:631-480-7278
Mailing Address - Fax:
Practice Address - Street 1:141 MARK TREE RD
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-2221
Practice Address - Country:US
Practice Address - Phone:631-467-4235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014477225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant