Provider Demographics
NPI:1891404687
Name:CANTALICIO, TCHAIKOVSKY JUNIOR JR (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:TCHAIKOVSKY
Middle Name:JUNIOR
Last Name:CANTALICIO
Suffix:JR
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550
Mailing Address - Country:US
Mailing Address - Phone:845-565-5054
Mailing Address - Fax:845-565-4071
Practice Address - Street 1:260 NORTH ST
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3131
Practice Address - Country:US
Practice Address - Phone:845-565-5054
Practice Address - Fax:845-565-4071
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049606-01261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy