Provider Demographics
NPI:1730334756
Name:SISON, BEN-HUR VERANO
Entity type:Individual
Prefix:
First Name:BEN-HUR
Middle Name:VERANO
Last Name:SISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311 49TH ST
Mailing Address - Street 2:APT 6I
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-1353
Mailing Address - Country:US
Mailing Address - Phone:305-753-1230
Mailing Address - Fax:718-346-2904
Practice Address - Street 1:43-11 49TH STREET
Practice Address - Street 2:APT 6I
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104
Practice Address - Country:US
Practice Address - Phone:305-753-1230
Practice Address - Fax:718-346-2904
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist