Provider Demographics
NPI:1275754616
Name:LINGAD, POCHOLO CORNELLIEUS (PT)
Entity Type:Individual
Prefix:
First Name:POCHOLO
Middle Name:CORNELLIEUS
Last Name:LINGAD
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 1:27 MATONE CIR
Mailing Address - Street 2:
Mailing Address - City:WEST HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10993-1256
Mailing Address - Country:US
Mailing Address - Phone:845-821-2551
Mailing Address - Fax:
Practice Address - Street 1:27 MATONE CIR
Practice Address - Street 2:
Practice Address - City:WEST HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993-1256
Practice Address - Country:US
Practice Address - Phone:845-821-2551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25046225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist