Provider Demographics
NPI:1912511098
Name:ROBINSON, ALVARO MAURICIO
Entity Type:Individual
Prefix:
First Name:ALVARO
Middle Name:MAURICIO
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 HARRISON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1211
Mailing Address - Country:US
Mailing Address - Phone:516-301-8345
Mailing Address - Fax:
Practice Address - Street 1:2728 HARRISON AVE FL 2
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1211
Practice Address - Country:US
Practice Address - Phone:516-301-8345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025340225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist