Provider Demographics
NPI:1588089486
Name:SISON, ERWIN (PT)
Entity type:Individual
Prefix:
First Name:ERWIN
Middle Name:
Last Name:SISON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9030 55TH AVE
Mailing Address - Street 2:3
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4561
Mailing Address - Country:US
Mailing Address - Phone:773-575-3644
Mailing Address - Fax:718-365-3749
Practice Address - Street 1:3201 GRAND CONCOURSE
Practice Address - Street 2:SUITE 1A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1247
Practice Address - Country:US
Practice Address - Phone:718-365-3747
Practice Address - Fax:718-365-3749
Is Sole Proprietor?:No
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY032355-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY032355OtherLICENSE