Provider Demographics
NPI:1912052747
Name:ESTEVEZ, PEDRO LUIS (OTRL)
Entity Type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:LUIS
Last Name:ESTEVEZ
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22122 106TH AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2431
Mailing Address - Country:US
Mailing Address - Phone:212-939-4438
Mailing Address - Fax:212-939-4405
Practice Address - Street 1:506 MALCOLM X BLVD
Practice Address - Street 2:3RD FL RM 3136
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1802
Practice Address - Country:US
Practice Address - Phone:212-939-4438
Practice Address - Fax:212-939-4405
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011762225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist