Healthcare Provider Details

I. General information

NPI: 1831678937
Provider Name (Legal Business Name): FREDERICK BAGANG CALARA RN, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 HEMPSTEAD TPKE
FRANKLIN SQUARE NY
11010-4339
US

IV. Provider business mailing address

2026 SEAGIRT BLVD APT 4B
FAR ROCKAWAY NY
11691-5908
US

V. Phone/Fax

Practice location:
  • Phone: 516-358-8911
  • Fax:
Mailing address:
  • Phone: 516-234-3049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number043063
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: