Provider Demographics
NPI:1336387992
Name:PE, DENNIS USTARES
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:USTARES
Last Name:PE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:3939 65TH ST. APT.2F
Mailing Address - Street 2:N/A
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377
Mailing Address - Country:US
Mailing Address - Phone:347-207-1031
Mailing Address - Fax:
Practice Address - Street 1:3939 65TH ST APT 2F
Practice Address - Street 2:N/A
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3624
Practice Address - Country:US
Practice Address - Phone:347-207-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist