Provider Demographics
NPI:1780706754
Name:NICANOR, LUDIVIC MOLINA (PT)
Entity type:Individual
Prefix:
First Name:LUDIVIC
Middle Name:MOLINA
Last Name:NICANOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LUDIVIC
Other - Middle Name:TIONGSON
Other - Last Name:NICANOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:783 ROCKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6415
Mailing Address - Country:US
Mailing Address - Phone:718-698-9000
Mailing Address - Fax:
Practice Address - Street 1:783 ROCKLAND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6415
Practice Address - Country:US
Practice Address - Phone:718-698-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022944225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist