Provider Demographics
NPI:1679803340
Name:ALGODON, NOEMI (PT)
Entity type:Individual
Prefix:
First Name:NOEMI
Middle Name:
Last Name:ALGODON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 ARGYLE RD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-1015
Mailing Address - Country:US
Mailing Address - Phone:516-385-6045
Mailing Address - Fax:
Practice Address - Street 1:13203 SANFORD AVE STE 1C
Practice Address - Street 2:PREMIUM MEDICAL CARE
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4310
Practice Address - Country:US
Practice Address - Phone:718-961-8881
Practice Address - Fax:718-961-4333
Is Sole Proprietor?:No
Enumeration Date:2010-01-01
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400050338OtherMEDICARE
NY03198616Medicaid