Provider Demographics
NPI:1073591244
Name:BADALAMENTE, MICHAEL S (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:S
Last Name:BADALAMENTE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 MAIN ST
Mailing Address - Street 2:FARMINGDALE PHYSICAL THERAPY
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735
Mailing Address - Country:US
Mailing Address - Phone:516-293-0565
Mailing Address - Fax:516-293-1897
Practice Address - Street 1:326 MAIN ST
Practice Address - Street 2:FARMINGDALE PHYSICAL THERAPY
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735
Practice Address - Country:US
Practice Address - Phone:516-293-0565
Practice Address - Fax:516-293-1897
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0120020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
64128OtherVYTRA
90754OtherAETNA
012002OtherHIP
NYP00429040OtherRR MEDICARE
2C2669OtherHEALTHNET
NYQ45191Medicare ID - Type Unspecified