Provider Demographics
NPI:1902183890
Name:FALCONE, CARL J (OT)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:J
Last Name:FALCONE
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-2351
Mailing Address - Country:US
Mailing Address - Phone:516-804-3045
Mailing Address - Fax:516-804-3045
Practice Address - Street 1:132 1ST AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-2351
Practice Address - Country:US
Practice Address - Phone:516-804-3045
Practice Address - Fax:516-804-3045
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008728225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist