Provider Demographics
NPI:1568516177
Name:DULAK, SMITA SAMANTHA (PTA)
Entity Type:Individual
Prefix:
First Name:SMITA
Middle Name:SAMANTHA
Last Name:DULAK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 8TH AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-4307
Mailing Address - Country:US
Mailing Address - Phone:212-213-0877
Mailing Address - Fax:212-213-2139
Practice Address - Street 1:258 W 91ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1108
Practice Address - Country:US
Practice Address - Phone:212-213-0877
Practice Address - Fax:212-213-2139
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0014401225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant