Provider Demographics
NPI:1699156463
Name:BUNQUIN, GLADYS MAY CHANCHICO (PT)
Entity type:Individual
Prefix:MS
First Name:GLADYS MAY
Middle Name:CHANCHICO
Last Name:BUNQUIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6395 AUSTIN ST
Mailing Address - Street 2:APT 2H
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3021
Mailing Address - Country:US
Mailing Address - Phone:516-603-9384
Mailing Address - Fax:
Practice Address - Street 1:13710 FRANKLIN AVE STE L2
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3842
Practice Address - Country:US
Practice Address - Phone:347-732-4297
Practice Address - Fax:347-732-4299
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY037095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist