Provider Demographics
NPI:1255364287
Name:VILLAPANDO, MAURINE ABARAHAM (PT)
Entity type:Individual
Prefix:MISS
First Name:MAURINE
Middle Name:ABARAHAM
Last Name:VILLAPANDO
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 SENNA DR
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-2513
Mailing Address - Country:US
Mailing Address - Phone:732-651-1485
Mailing Address - Fax:
Practice Address - Street 1:11020 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2324
Practice Address - Country:US
Practice Address - Phone:718-850-4644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist