Healthcare Provider Details

I. General information

NPI: 1366405300
Provider Name (Legal Business Name): AYALA J USDIN MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 BROADWAY STE 204
NEW YORK NY
10023-2106
US

IV. Provider business mailing address

101 W 81ST ST #301
NEW YORK NY
10024-7210
US

V. Phone/Fax

Practice location:
  • Phone: 212-799-0160
  • Fax: 212-799-0209
Mailing address:
  • Phone: 212-496-0006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number021162
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: