Provider Demographics
NPI:1366405300
Name:USDIN, AYALA J (MSPT)
Entity type:Individual
Prefix:MRS
First Name:AYALA
Middle Name:J
Last Name:USDIN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 81ST ST
Mailing Address - Street 2:#301
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-7210
Mailing Address - Country:US
Mailing Address - Phone:212-496-0006
Mailing Address - Fax:
Practice Address - Street 1:2109 BROADWAY
Practice Address - Street 2:STE 204
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2106
Practice Address - Country:US
Practice Address - Phone:212-799-0160
Practice Address - Fax:212-799-0209
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQP9891Medicare ID - Type Unspecified