Provider Demographics
NPI:1255512091
Name:GUE, APO BURCA JR
Entity type:Individual
Prefix:
First Name:APO
Middle Name:BURCA
Last Name:GUE
Suffix:JR
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 1:520 W 218TH ST
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-1020
Mailing Address - Country:US
Mailing Address - Phone:212-304-1755
Mailing Address - Fax:212-304-4308
Practice Address - Street 1:520 W 218TH ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1020
Practice Address - Country:US
Practice Address - Phone:212-304-1755
Practice Address - Fax:212-304-4308
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025309-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist