Healthcare Provider Details

I. General information

NPI: 1902713720
Provider Name (Legal Business Name): PHILIP KODANGAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CIVIC CENTER PLZ STE 107
POUGHKEEPSIE NY
12601-3158
US

IV. Provider business mailing address

26 COBBLESTONE LN
MIDDLETOWN NY
10940-5090
US

V. Phone/Fax

Practice location:
  • Phone: 845-483-7777
  • Fax:
Mailing address:
  • Phone: 601-316-0561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number015484-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: