Provider Demographics
NPI:1134417496
Name:GOODEN-PULIDO, STEFANIE (DPT)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:GOODEN-PULIDO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 7TH AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6708
Mailing Address - Country:US
Mailing Address - Phone:212-812-3558
Mailing Address - Fax:212-812-3614
Practice Address - Street 1:275 7TH AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6708
Practice Address - Country:US
Practice Address - Phone:212-812-3558
Practice Address - Fax:212-812-3614
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033462-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist