Provider Demographics
NPI:1427472521
Name:OPTIMAL PTA WELLNESS
Entity type:Organization
Organization Name:OPTIMAL PTA WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAGASA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-606-9378
Mailing Address - Street 1:8716 QUEENS BLVD
Mailing Address - Street 2:GROUND LEVEL
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4419
Mailing Address - Country:US
Mailing Address - Phone:718-606-9378
Mailing Address - Fax:718-606-9360
Practice Address - Street 1:8716 QUEENS BLVD
Practice Address - Street 2:GROUND LEVEL
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4419
Practice Address - Country:US
Practice Address - Phone:718-606-9378
Practice Address - Fax:718-606-9360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty