Provider Demographics
NPI:1316375892
Name:TATAY NINONG PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:TATAY NINONG PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL KRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGUBAT
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:347-605-7946
Mailing Address - Street 1:3344 105TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-1121
Mailing Address - Country:US
Mailing Address - Phone:347-605-7946
Mailing Address - Fax:
Practice Address - Street 1:7909B NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1223
Practice Address - Country:US
Practice Address - Phone:718-507-1438
Practice Address - Fax:718-507-1530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029005261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy