Provider Demographics
NPI:1154422483
Name:PATINA, INESSA (DPT)
Entity type:Individual
Prefix:
First Name:INESSA
Middle Name:
Last Name:PATINA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:INESSA
Other - Middle Name:
Other - Last Name:PATINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:160 NATHAN DR
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-2238
Mailing Address - Country:US
Mailing Address - Phone:917-309-2582
Mailing Address - Fax:
Practice Address - Street 1:6417 BAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3930
Practice Address - Country:US
Practice Address - Phone:718-234-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027006-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ20R31Medicare PIN