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General NPI Number Information
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NPI Number | 1427472521
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Entity Type | Organization
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Legal Business Name | OPTIMAL PTA WELLNESS
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Dates
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Enumeration Date | 02/10/2014
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Last Update Date | 02/10/2014
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Provider Practice Location Address
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Address Line | 8716 QUEENS BLVD GROUND LEVEL
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City | ELMHURST
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State | NY
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Zip | 11373-4419
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Country | US
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Telephone | 718-606-9378
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Fax | 718-606-9360
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Provider Business Mailing Address
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Address Line | 8716 QUEENS BLVD GROUND LEVEL
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City | ELMHURST
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State | NY
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Zip | 11373-4419
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Country | US
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Telephone | 718-606-9378
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Fax | 718-606-9360
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Authorized Official
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Title or Position | OWNER
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Name | MR. OSCAR R RAGASA
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Credential |
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Telephone | 718-606-9378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number |
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License Number State |
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