Provider Demographics
NPI:1194090316
Name:COMMISSIONG, NATASHA CHRISTINA (DPT)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:CHRISTINA
Last Name:COMMISSIONG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103-22 ROCKAWAY BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2739
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:185 MONTAGUE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11201-3600
Practice Address - Country:US
Practice Address - Phone:718-243-9900
Practice Address - Fax:718-243-1620
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034457-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ4WFH1Medicare PIN