Provider Demographics
NPI:1760659239
Name:MALCAN PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:MALCAN PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:BUENAVENTURA
Authorized Official - Last Name:DELA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-749-6838
Mailing Address - Street 1:7805 270TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1527
Mailing Address - Country:US
Mailing Address - Phone:718-749-6838
Mailing Address - Fax:718-343-2317
Practice Address - Street 1:5011 QUEENS BLVD BSMT
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4469
Practice Address - Country:US
Practice Address - Phone:718-749-6838
Practice Address - Fax:718-343-2317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017983-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06381Medicare PIN