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General NPI Number Information
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NPI Number | 1437764941
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Entity Type | Individual
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Provider Name | NICHOLAS MADDALENA DPT
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Gender | Male
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Dates
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Enumeration Date | 09/11/2020
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Last Update Date | 09/11/2020
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Provider Practice Location Address
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Address Line | 1875 PALMER AVE # 106
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City | LARCHMONT
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State | NY
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Zip | 10538-3053
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Country | US
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Telephone | 914-826-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 3360 SPRUCE ST
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City | MOHEGAN LAKE
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State | NY
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Zip | 10547-1411
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Country | US
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Telephone | 914-382-4615
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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