Provider Demographics
NPI:1962798736
Name:DE JESUS, EMMANUEL ZAPANTA (RPT)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:ZAPANTA
Last Name:DE JESUS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BOGOTA ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6224
Mailing Address - Country:US
Mailing Address - Phone:661-889-4906
Mailing Address - Fax:718-351-3656
Practice Address - Street 1:15 BOGOTA ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314
Practice Address - Country:US
Practice Address - Phone:661-889-4906
Practice Address - Fax:718-351-3656
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030233-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY030233-1OtherLICENSE#