Healthcare Provider Details

I. General information

NPI: 1942849401
Provider Name (Legal Business Name): JOSEPH CHARLES CESTARO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 BROADWAY
NEW YORK NY
10006-2503
US

IV. Provider business mailing address

21 MERCER PL
STATEN ISLAND NY
10308-3430
US

V. Phone/Fax

Practice location:
  • Phone: 212-514-6499
  • Fax:
Mailing address:
  • Phone: 718-564-4387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number045099
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: