Provider Demographics
NPI:1316367675
Name:BANAY, MICHAEL BAMBAO (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BAMBAO
Last Name:BANAY
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 1:240 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-5602
Mailing Address - Country:US
Mailing Address - Phone:212-473-3703
Mailing Address - Fax:212-473-3709
Practice Address - Street 1:229 EAST 21ST STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:212-473-3703
Practice Address - Fax:212-473-3709
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032808225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist