Individual
MR. JESUBIELIN CUSTODIO PERONILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
3808 23RD AVE APT 1F, ASTORIA, NY 11105-1963
(347) 350-1235
Mailing address
3808 23RD AVE APT 1F, ASTORIA, NY 11105-1963
(347) 350-1235
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
050395
NY
Other
Enumeration date
02/11/2025
Last updated
02/11/2025
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