Provider Demographics
NPI:1790380079
Name:PALAMATTATHIL JOSEPH, JOHN (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:PALAMATTATHIL JOSEPH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:
Other - Last Name:PALAMATTATHIL JOHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:30 DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2051
Mailing Address - Country:US
Mailing Address - Phone:516-232-7920
Mailing Address - Fax:516-466-7723
Practice Address - Street 1:30 DURHAM RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2051
Practice Address - Country:US
Practice Address - Phone:516-232-7920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty