Healthcare Provider Details

I. General information

NPI: 1922924901
Provider Name (Legal Business Name): GLEIZA KLOUIE GEONZON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 HONE AVE
BRONX NY
10461-1406
US

IV. Provider business mailing address

1811 HONE AVE
BRONX NY
10461-1406
US

V. Phone/Fax

Practice location:
  • Phone: 718-518-1133
  • Fax:
Mailing address:
  • Phone: 718-518-1133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number050030
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: