Provider Demographics
NPI:1972578656
Name:SPALLONE, JOSEPH D (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:D
Last Name:SPALLONE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W 23RD ST
Mailing Address - Street 2:FUNCTION FIRST PHYSICAL THERAPY, SUITE 804
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2427
Mailing Address - Country:US
Mailing Address - Phone:212-691-4833
Mailing Address - Fax:212-691-4532
Practice Address - Street 1:119 W 23RD ST
Practice Address - Street 2:FUNCTION FIRST PHYSICAL THERAPY, SUITE 804
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2427
Practice Address - Country:US
Practice Address - Phone:212-691-4833
Practice Address - Fax:212-691-4532
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011932174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ86601Medicare PIN