Healthcare Provider Details

I. General information

NPI: 1588577811
Provider Name (Legal Business Name): LAZILCON PALALON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAZILCON MAE ELUMBARING PALALON

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HIGHLAND AVE
MIDDLETOWN NY
10940-4713
US

IV. Provider business mailing address

15 MILLER HEIGHTS RD
MIDDLETOWN NY
10940-6606
US

V. Phone/Fax

Practice location:
  • Phone: 775-342-5260
  • Fax:
Mailing address:
  • Phone: 775-342-5260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number045554-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: