Provider Demographics
NPI:1497584726
Name:MASTROPOLO, CANDILORO JOHN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:CANDILORO
Middle Name:JOHN
Last Name:MASTROPOLO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 OLD ORANGEBURG RD BLDG 57
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-1154
Mailing Address - Country:US
Mailing Address - Phone:845-548-4616
Mailing Address - Fax:
Practice Address - Street 1:140 OLD ORANGEBURG RD BLDG 57
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-1154
Practice Address - Country:US
Practice Address - Phone:845-548-4616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018777-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist