Individual
THARA KRISTELLE ENERIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
26717 HILLSIDE AVE, GLEN OAKS, NY 11004-1743
(718) 343-2121
Mailing address
3433 62ND ST, WOODSIDE, NY 11377-2147
(908) 416-3155
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
043504-1
NY
Other
Enumeration date
11/16/2020
Last updated
11/16/2020
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