Healthcare Provider Details

I. General information

NPI: 1023262821
Provider Name (Legal Business Name): DONNA MARIE KOWALCZYK-FALCONE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 1ST AVE
MASSAPEQUA PARK NY
11762-2351
US

IV. Provider business mailing address

132 1ST AVE
MASSAPEQUA PARK NY
11762-2351
US

V. Phone/Fax

Practice location:
  • Phone: 917-868-8855
  • Fax: 516-804-3045
Mailing address:
  • Phone: 917-868-8855
  • Fax: 516-804-3045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number017625
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: