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General NPI Number Information
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NPI Number | 1043517790
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Entity Type | Organization
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Legal Business Name | SUDARA PT PC
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Dates
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Enumeration Date | 02/15/2011
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Last Update Date | 02/15/2011
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Provider Practice Location Address
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Address Line | 5327 18TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11204-1523
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Country | US
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Telephone | 718-236-7707
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Fax | 718-236-3300
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Provider Business Mailing Address
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Address Line | 5327 18TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11204-1523
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Country | US
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Telephone | 718-236-7707
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Fax | 718-236-3300
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Authorized Official
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Title or Position | P.T.
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Name | DAVID PEREZ- HERRANZ
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Credential | P.T.
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Telephone | 718-236-7707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 030017-1
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License Number State | NY
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