Provider Demographics
NPI:1831258193
Name:BRANCALE, PATRICIA ANN (MSPT)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:BRANCALE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5607
Mailing Address - Country:US
Mailing Address - Phone:718-943-7100
Mailing Address - Fax:718-786-9798
Practice Address - Street 1:1043 48TH AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5607
Practice Address - Country:US
Practice Address - Phone:718-943-7100
Practice Address - Fax:718-786-9798
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022838-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07150GMedicare ID - Type UnspecifiedGHI MEDICARE INDIVIDUAL
NY07150Medicare ID - Type UnspecifiedGHI MEDICARE