Provider Demographics
NPI:1437764941
Name:MADDALENA, NICHOLAS (DPT)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:MADDALENA
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 1:3360 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:MOHEGAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10547-1411
Mailing Address - Country:US
Mailing Address - Phone:914-382-4615
Mailing Address - Fax:
Practice Address - Street 1:1875 PALMER AVE # 106
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3053
Practice Address - Country:US
Practice Address - Phone:914-826-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy