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General NPI Number Information
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NPI Number | 1518044700
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Entity Type | Organization
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Legal Business Name | MARIO SALONGA, PT
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/14/2012
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Provider Practice Location Address
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Address Line | 228 BEACH 20TH ST
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-3618
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Country | US
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Telephone | 718-471-6500
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Fax | 718-327-6542
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Provider Business Mailing Address
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Address Line | 228 BEACH 20TH ST
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-3618
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Country | US
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Telephone | 718-471-6500
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Fax | 718-327-6542
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Authorized Official
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Title or Position | PT
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Name | MR. MARIO CASTILLO SALONGA
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Credential | PT
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Telephone | 718-471-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 011345
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License Number State | NY
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