Provider Demographics
NPI:1356487953
Name:MASANGYA, RANDEE CARREON (PT)
Entity Type:Individual
Prefix:MR
First Name:RANDEE
Middle Name:CARREON
Last Name:MASANGYA
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 1:126 CODY PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1690
Mailing Address - Country:US
Mailing Address - Phone:718-984-8572
Mailing Address - Fax:
Practice Address - Street 1:330 W 34TH ST
Practice Address - Street 2:15TH FL.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2406
Practice Address - Country:US
Practice Address - Phone:212-947-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019737-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist