Individual
JEDD LOUIE DIANGO ROSALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
5630 MYRTLE AVE, RIDGEWOOD, NY 11385-4736
(718) 400-7500
Mailing address
8106 45TH AVE, ELMHURST, NY 11373-3557
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
053904
NY
Other
Enumeration date
10/08/2025
Last updated
10/08/2025
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