Provider Demographics
NPI:1396536785
Name:PASSALACQUA, MADDALENA
Entity type:Individual
Prefix:
First Name:MADDALENA
Middle Name:
Last Name:PASSALACQUA
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WHITNEY RD
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11709-2406
Mailing Address - Country:US
Mailing Address - Phone:516-680-9776
Mailing Address - Fax:
Practice Address - Street 1:3 WHITNEY RD
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11709-2406
Practice Address - Country:US
Practice Address - Phone:516-680-9776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018136225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist