Provider Demographics
NPI:1295870079
Name:BADALAMENTI, TORY MICHAEL (PT)
Entity type:Individual
Prefix:
First Name:TORY
Middle Name:MICHAEL
Last Name:BADALAMENTI
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 1:112 BIDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3177
Mailing Address - Country:US
Mailing Address - Phone:718-637-4603
Mailing Address - Fax:718-448-8287
Practice Address - Street 1:112 BIDWELL AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3177
Practice Address - Country:US
Practice Address - Phone:718-637-4603
Practice Address - Fax:718-448-8287
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0179902251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300016430Medicare PIN