Provider Demographics
NPI:1346578754
Name:CHAN, CARLO PONTI (DPT)
Entity Type:Individual
Prefix:
First Name:CARLO
Middle Name:PONTI
Last Name:CHAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W 79TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6283
Mailing Address - Country:US
Mailing Address - Phone:212-874-1550
Mailing Address - Fax:212-874-1599
Practice Address - Street 1:248 W 80TH ST
Practice Address - Street 2:5TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-7608
Practice Address - Country:US
Practice Address - Phone:212-874-1550
Practice Address - Fax:212-874-1599
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0-30011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist