Provider Demographics
NPI:1871806141
Name:QUEZON, GEORGE HIDALGO
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:HIDALGO
Last Name:QUEZON
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 1:130 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1600
Mailing Address - Country:US
Mailing Address - Phone:973-320-5194
Mailing Address - Fax:
Practice Address - Street 1:4951 CHAMBERS STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1209
Practice Address - Country:US
Practice Address - Phone:917-286-5147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist