Provider Demographics
NPI:1164736757
Name:MANALAC, BENJAMIN CALMA (BSPT)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:CALMA
Last Name:MANALAC
Suffix:
Gender:M
Credentials:BSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6918 59TH RD
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-2920
Mailing Address - Country:US
Mailing Address - Phone:646-623-9511
Mailing Address - Fax:
Practice Address - Street 1:6918 59TH RD
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-2920
Practice Address - Country:US
Practice Address - Phone:646-623-9511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031334225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist