Healthcare Provider Details

I. General information

NPI: 1679866016
Provider Name (Legal Business Name): GARY SARMIENTO ABANO DPT, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 FAIRFIELD AVE APT 7L
BRONX NY
10463-3349
US

IV. Provider business mailing address

3050 FAIRFIELD AVE APT 7L
BRONX NY
10463-3349
US

V. Phone/Fax

Practice location:
  • Phone: 917-705-3866
  • Fax:
Mailing address:
  • Phone: 917-705-3866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number031848
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number031848
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: