Provider Demographics
NPI:1548306335
Name:PAQUEO, ROLAND (DPT)
Entity type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:
Last Name:PAQUEO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9245 53RD AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4624
Mailing Address - Country:US
Mailing Address - Phone:646-431-3097
Mailing Address - Fax:718-770-7681
Practice Address - Street 1:8960 56TH AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4933
Practice Address - Country:US
Practice Address - Phone:718-535-7288
Practice Address - Fax:718-770-7681
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NY022730225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist