Provider Demographics
NPI:1093137010
Name:PANILAG, KIRPAL CANDY (PT)
Entity Type:Individual
Prefix:
First Name:KIRPAL CANDY
Middle Name:
Last Name:PANILAG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9850 63RD DR APT 4F
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2312
Mailing Address - Country:US
Mailing Address - Phone:347-901-8592
Mailing Address - Fax:
Practice Address - Street 1:7909 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON HTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1223
Practice Address - Country:US
Practice Address - Phone:347-901-8592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2021-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0358812251X0800X
NY035581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY628727472OtherDRIVERS LICENSE