Healthcare Provider Details

I. General information

NPI: 1437764941
Provider Name (Legal Business Name): NICHOLAS MADDALENA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 W POST RD
WHITE PLAINS NY
10606-2937
US

IV. Provider business mailing address

68 CLOVERDALE AVE
WHITE PLAINS NY
10603-3240
US

V. Phone/Fax

Practice location:
  • Phone: 914-584-6564
  • Fax: 914-303-5033
Mailing address:
  • Phone: 914-382-4615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: