Provider Demographics
NPI:1538169735
Name:ESTRELLA, CONSOLACION OBEDO (PT)
Entity type:Individual
Prefix:MS
First Name:CONSOLACION
Middle Name:OBEDO
Last Name:ESTRELLA
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 1:787 LYDIG AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-2144
Mailing Address - Country:US
Mailing Address - Phone:718-863-7774
Mailing Address - Fax:718-792-0288
Practice Address - Street 1:787 LYDIG AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-2144
Practice Address - Country:US
Practice Address - Phone:718-863-7774
Practice Address - Fax:718-792-0288
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY018236OtherHIP
NY11303OtherMAGNACARE
NY2234571OtherFIRST HEALTH
NY9525118OtherCIGNA
NY2439101OtherUNITED HEALTHCARE
NY6697223OtherGHI
NYQ12V41Medicare ID - Type UnspecifiedINDIVIDUAL
NYQ5W4V1Medicare ID - Type UnspecifiedGROUP
NYY34966Medicare UPIN
NY2234571OtherFIRST HEALTH