Provider Demographics
NPI:1104177153
Name:BIAZON, EDGAR JOSEPH (PT)
Entity type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:JOSEPH
Last Name:BIAZON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 WESTERVELT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1650
Mailing Address - Country:US
Mailing Address - Phone:516-208-5005
Mailing Address - Fax:516-208-5005
Practice Address - Street 1:1633 WESTERVELT AVE
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-1650
Practice Address - Country:US
Practice Address - Phone:516-208-5005
Practice Address - Fax:516-208-5005
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017711-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist