Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 017990 | NY |
NPI | 1295870079 |
---|---|
Provider Name | Tory Michael Badalamenti |
First Address | Staten Island, NY 10314-3177 |
Second Address | Staten Island, NY 10314-3177 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 29/10/2009 |