Provider Demographics
NPI:1740246479
Name:BELTRAN, GERALDINE ABONETE (PT)
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:ABONETE
Last Name:BELTRAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:GERALDINE
Other - Middle Name:ABONETE
Other - Last Name:LUSAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1993 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-2719
Mailing Address - Country:US
Mailing Address - Phone:631-242-8172
Mailing Address - Fax:631-242-4907
Practice Address - Street 1:1993 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-2719
Practice Address - Country:US
Practice Address - Phone:631-242-8172
Practice Address - Fax:631-242-4907
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ6U71Medicare ID - Type Unspecified