Provider Demographics
NPI:1245315357
Name:PAQUEO, AGNES B (PT)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:B
Last Name:PAQUEO
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 1:1 VINCENT RD
Mailing Address - Street 2:APT. 3G
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-6518
Mailing Address - Country:US
Mailing Address - Phone:914-964-4031
Mailing Address - Fax:914-964-4031
Practice Address - Street 1:MMG - CROSS COUNTY
Practice Address - Street 2:1010 CENTRAL PARK AVENUE
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704
Practice Address - Country:US
Practice Address - Phone:914-964-4031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist