Provider Demographics
NPI:1295296911
Name:VEGA GARCIA, MAIDY JOCELYN (PTA)
Entity type:Individual
Prefix:
First Name:MAIDY
Middle Name:JOCELYN
Last Name:VEGA GARCIA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2439 27TH ST APT 3A
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2368
Mailing Address - Country:US
Mailing Address - Phone:201-660-0485
Mailing Address - Fax:
Practice Address - Street 1:150 W END AVE APT 1M
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5715
Practice Address - Country:US
Practice Address - Phone:212-600-4781
Practice Address - Fax:800-655-3780
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011430-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant