Provider Demographics
NPI:1669122131
Name:CYRIAC, JOHNY ACKAMPARAMBIL
Entity type:Individual
Prefix:
First Name:JOHNY
Middle Name:ACKAMPARAMBIL
Last Name:CYRIAC
Suffix:
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 1:8264 268TH ST
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1562
Mailing Address - Country:US
Mailing Address - Phone:718-344-8666
Mailing Address - Fax:
Practice Address - Street 1:8264 268TH ST
Practice Address - Street 2:
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1562
Practice Address - Country:US
Practice Address - Phone:718-344-8666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-26
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005943225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty