Provider Demographics
NPI:1679679351
Name:DIMALANTA, OSWALD CARNEO (PT)
Entity Type:Individual
Prefix:MR
First Name:OSWALD
Middle Name:CARNEO
Last Name:DIMALANTA
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 1:3 REGAL CT
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-4101
Mailing Address - Country:US
Mailing Address - Phone:732-821-0005
Mailing Address - Fax:
Practice Address - Street 1:1400 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3362
Practice Address - Country:US
Practice Address - Phone:908-753-1113
Practice Address - Fax:908-753-1809
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01029600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist