Healthcare Provider Details

I. General information

NPI: 1790380079
Provider Name (Legal Business Name): JOHN PALAMATTATHIL JOSEPH PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOSEPH PALAMATTATHIL JOHN DPT

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 DURHAM RD
NEW HYDE PARK NY
11040-2051
US

IV. Provider business mailing address

30 DURHAM RD
NEW HYDE PARK NY
11040-2051
US

V. Phone/Fax

Practice location:
  • Phone: 516-232-7920
  • Fax:
Mailing address:
  • Phone: 516-232-7920
  • Fax: 516-466-7723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number045871
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: