Provider Demographics
NPI:1285246603
Name:RAMOS, FAUSTINO M (PT)
Entity type:Individual
Prefix:
First Name:FAUSTINO
Middle Name:M
Last Name:RAMOS
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 1:786 EVERGREEN PKWY
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-8706
Mailing Address - Country:US
Mailing Address - Phone:917-385-2677
Mailing Address - Fax:
Practice Address - Street 1:2003 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2328
Practice Address - Country:US
Practice Address - Phone:917-385-2677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013255225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist