Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 30109 | NY |
N | 225100000X | Physical Therapist | 40QA01319000 | NJ |
N | 2251G0304X | Physical Therapist - Geriatrics | 40QA01319000 | NJ |
NPI | 1265566103 |
---|---|
Provider Name | Ralph Waldo Cuartero |
First Address | Maspeth, NY 11378-0173 |
Second Address | Elmwood Park, NJ 07407-2009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 29/01/2020 |