Healthcare Provider Details

I. General information

NPI: 1144551938
Provider Name (Legal Business Name): DIANA E ESPINOSA-PERKUL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2010
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 LENOX AVE MLK BUILDING, ROOM 3137
NEW YORK NY
10037-1802
US

IV. Provider business mailing address

102 OAKLAND RD
MAPLEWOOD NJ
07040-2306
US

V. Phone/Fax

Practice location:
  • Phone: 212-939-4442
  • Fax:
Mailing address:
  • Phone: 718-541-7968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number006331-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: