Provider Demographics
NPI:1639487721
Name:MATAGA, MINGLANILLA CELIS
Entity Type:Individual
Prefix:
First Name:MINGLANILLA
Middle Name:CELIS
Last Name:MATAGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 E 21ST ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-6433
Mailing Address - Country:US
Mailing Address - Phone:212-473-3703
Mailing Address - Fax:212-473-3709
Practice Address - Street 1:229 E 21ST ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6433
Practice Address - Country:US
Practice Address - Phone:212-473-3703
Practice Address - Fax:212-473-3709
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032140-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist