Provider Demographics
NPI:1225283179
Name:FARAGO, DAHLIA JOY (MPT)
Entity Type:Individual
Prefix:
First Name:DAHLIA
Middle Name:JOY
Last Name:FARAGO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2732
Mailing Address - Country:US
Mailing Address - Phone:516-612-4640
Mailing Address - Fax:
Practice Address - Street 1:616 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2732
Practice Address - Country:US
Practice Address - Phone:516-612-4640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026495-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics