Healthcare Provider Details

I. General information

NPI: 1902761323
Provider Name (Legal Business Name): BODY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8686 BAY PKWY
BROOKLYN NY
11214-5119
US

IV. Provider business mailing address

6 LITCHULT CT
AIRMONT NY
10901-7511
US

V. Phone/Fax

Practice location:
  • Phone: 347-605-7946
  • Fax: 718-585-0880
Mailing address:
  • Phone: 347-605-7946
  • Fax: 718-585-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL KRISTIAN MANGUBAT
Title or Position: CEO
Credential:
Phone: 347-605-7946