Provider Demographics
NPI:1831678937
Name:CALARA, FREDERICK BAGANG (RN, PT)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:BAGANG
Last Name:CALARA
Suffix:
Gender:M
Credentials:RN, PT
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2026 SEAGIRT BLVD APT 4B
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5908
Mailing Address - Country:US
Mailing Address - Phone:516-234-3049
Mailing Address - Fax:
Practice Address - Street 1:820 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-4339
Practice Address - Country:US
Practice Address - Phone:516-358-8911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY043063225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist