Provider Demographics
NPI:1144409319
Name:DULANGON, TRISTAN REYES (PT)
Entity Type:Individual
Prefix:
First Name:TRISTAN
Middle Name:REYES
Last Name:DULANGON
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 1:151 E 67TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-5964
Mailing Address - Country:US
Mailing Address - Phone:212-988-9500
Mailing Address - Fax:212-628-9193
Practice Address - Street 1:151 E 67TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-5964
Practice Address - Country:US
Practice Address - Phone:212-988-9500
Practice Address - Fax:212-628-9193
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist