Provider Demographics
NPI:1316774524
Name:ROSARIO, JOSHUA MATTHEW DEVERALA (PT)
Entity type:Individual
Prefix:
First Name:JOSHUA MATTHEW
Middle Name:DEVERALA
Last Name:ROSARIO
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 1:3230, 93RD ST. , EAST ELMHURST
Mailing Address - Street 2:APT. D3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:11369
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 EAST 34TH
Practice Address - Street 2:SUITE 1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-651-4380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050400-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist