Provider Demographics
NPI:1598056921
Name:FALANA, GBENGA JOHN (DPT)
Entity Type:Individual
Prefix:DR
First Name:GBENGA
Middle Name:JOHN
Last Name:FALANA
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 1:915 LYNN DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1221
Mailing Address - Country:US
Mailing Address - Phone:718-414-4588
Mailing Address - Fax:
Practice Address - Street 1:915 LYNN DR
Practice Address - Street 2:SUITE 101
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-1221
Practice Address - Country:US
Practice Address - Phone:718-414-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013411-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist