Healthcare Provider Details

I. General information

NPI: 1720716269
Provider Name (Legal Business Name): MARIO PALADA PALISOC PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7146 110TH ST
FOREST HILLS NY
11375-4871
US

IV. Provider business mailing address

7146 110TH ST GROUND LEVEL
FOREST HILLS NY
11375-4871
US

V. Phone/Fax

Practice location:
  • Phone: 718-687-2474
  • Fax: 347-829-3113
Mailing address:
  • Phone: 718-687-2474
  • Fax: 347-829-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: