Provider Demographics
NPI:1689908907
Name:PENALBA, MAY PEGOLLO (PT)
Entity Type:Individual
Prefix:MS
First Name:MAY
Middle Name:PEGOLLO
Last Name:PENALBA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2385 YORK ST
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-3014
Mailing Address - Country:US
Mailing Address - Phone:516-477-4471
Mailing Address - Fax:
Practice Address - Street 1:67 IRVING PL FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2237
Practice Address - Country:US
Practice Address - Phone:212-673-7500
Practice Address - Fax:212-420-8250
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030948-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist