Provider Demographics
NPI:1972556033
Name:MADDALONE, KATHLEEN (PT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MADDALONE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:CITARRELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:38 HARBOR PARK DR
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-4602
Mailing Address - Country:US
Mailing Address - Phone:718-746-0070
Mailing Address - Fax:516-441-5441
Practice Address - Street 1:38 HARBOR PARK DR
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-4602
Practice Address - Country:US
Practice Address - Phone:718-746-0070
Practice Address - Fax:516-441-5441
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03248NMedicare ID - Type UnspecifiedGHI MEDICARE
NYQ15X41Medicare ID - Type UnspecifiedEMPIRE MEDICARE