Provider Demographics
NPI:1881832244
Name:SECIO, ENRICA GONESTO (PT)
Entity type:Individual
Prefix:MISS
First Name:ENRICA
Middle Name:GONESTO
Last Name:SECIO
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 1:8 HEWITT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4614
Mailing Address - Country:US
Mailing Address - Phone:240-413-7998
Mailing Address - Fax:
Practice Address - Street 1:80 RIVER ST
Practice Address - Street 2:SUITE 5A
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5626
Practice Address - Country:US
Practice Address - Phone:201-377-1888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01303000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist