Provider Demographics
NPI:1740484716
Name:GONZALES, MARIA CONSUELO BAQUIRAN (PT)
Entity type:Individual
Prefix:
First Name:MARIA CONSUELO
Middle Name:BAQUIRAN
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 EAST 21ST ST.
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010
Mailing Address - Country:US
Mailing Address - Phone:212-387-8124
Mailing Address - Fax:212-473-3709
Practice Address - Street 1:229 EAST 21ST ST.
Practice Address - Street 2:MEDICAL DYNAMIC SYSTEMS INCORPORATED
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:212-387-8124
Practice Address - Fax:212-473-3709
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2237J1Medicare PIN
NY2237JWS861Medicare PIN