Provider Demographics
NPI:1124731211
Name:PUGUON, MARISCIEL N
Entity type:Individual
Prefix:
First Name:MARISCIEL
Middle Name:N
Last Name:PUGUON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 HAYTS RD APT 3
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-9218
Mailing Address - Country:US
Mailing Address - Phone:607-272-8282
Mailing Address - Fax:
Practice Address - Street 1:272 HAYTS RD APT 3
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-9218
Practice Address - Country:US
Practice Address - Phone:845-505-2825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03993601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist