Provider Demographics
NPI:1427262054
Name:DE FELIPE, CARLO FLAVIANO (PT)
Entity type:Individual
Prefix:
First Name:CARLO
Middle Name:FLAVIANO
Last Name:DE FELIPE
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 1:1096 GRUBER AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5008
Mailing Address - Country:US
Mailing Address - Phone:908-688-6148
Mailing Address - Fax:
Practice Address - Street 1:350 FIFTH AVE
Practice Address - Street 2:SUITE 5115
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10118
Practice Address - Country:US
Practice Address - Phone:866-696-8773
Practice Address - Fax:212-928-9545
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025226-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist