Provider Demographics
NPI:1063787927
Name:AVES, ISAGANI
Entity type:Individual
Prefix:
First Name:ISAGANI
Middle Name:
Last Name:AVES
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 1:750 JENNINGS ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-1204
Mailing Address - Country:US
Mailing Address - Phone:718-378-0006
Mailing Address - Fax:718-589-9544
Practice Address - Street 1:750 JENNINGS ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-1204
Practice Address - Country:US
Practice Address - Phone:718-378-0006
Practice Address - Fax:718-589-9544
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030774225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist