Provider Demographics
NPI:1205340270
Name:ABRENICA, JOSEPH EDWIN VILLACORTE (BSPT)
Entity type:Individual
Prefix:
First Name:JOSEPH EDWIN
Middle Name:VILLACORTE
Last Name:ABRENICA
Suffix:
Gender:M
Credentials:BSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5741 157TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5518
Mailing Address - Country:US
Mailing Address - Phone:850-832-9535
Mailing Address - Fax:
Practice Address - Street 1:5741 157TH ST FL 1
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5518
Practice Address - Country:US
Practice Address - Phone:850-832-9535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039896-1225100000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist