Provider Demographics
NPI:1073609632
Name:SCALAMANDRE, JOHN M (PT DPT)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:SCALAMANDRE
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:185 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901
Mailing Address - Country:US
Mailing Address - Phone:631-208-4443
Mailing Address - Fax:631-208-4448
Practice Address - Street 1:185 OLD COUNTRY RD
Practice Address - Street 2:SUITE 4
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901
Practice Address - Country:US
Practice Address - Phone:631-208-4443
Practice Address - Fax:631-208-4448
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0138951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
QL8661Medicare ID - Type Unspecified
NYJS0QL86610Medicare PIN