Individual
MR. BIENVENIDO PONCARDAS CEBALLOS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BSPT
Contact information
Practice address
55 POST AVE, STE 205, WESTBURY, NY 11590-4361
(516) 338-0412
(516) 338-1106
Mailing address
15 MONMOUTH ST, DEER PARK, NY 11729-2514
(631) 839-4061
(631) 274-5940
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
019520
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02330692
—
NY
Enumeration date
02/02/2007
Last updated
07/09/2007
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