Healthcare Provider Details

I. General information

NPI: 1578050852
Provider Name (Legal Business Name): THOMAS BABY VAZHAKALAYIL DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2018
Last Update Date: 04/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SHELTER HILL RD
PLAINVIEW NY
11803-4829
US

IV. Provider business mailing address

50 SHELTER HILL RD
PLAINVIEW NY
11803-4829
US

V. Phone/Fax

Practice location:
  • Phone: 617-633-2923
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number038679
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: