Provider Demographics
NPI:1932125689
Name:KALTEN, EDWARD W JR (PT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:W
Last Name:KALTEN
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:206 N IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:N MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1323
Mailing Address - Country:US
Mailing Address - Phone:516-293-8224
Mailing Address - Fax:631-328-5921
Practice Address - Street 1:53 BRENTWOOD RD
Practice Address - Street 2:SUITE B
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6923
Practice Address - Country:US
Practice Address - Phone:631-328-5920
Practice Address - Fax:631-328-5921
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY021499225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQN3581Medicare PIN