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General NPI Number Information
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NPI Number | 1629922810
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Entity Type | Individual
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Provider Name | MARCO BALATBAT PENA
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Gender | Male
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Dates
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Enumeration Date | 02/24/2026
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Last Update Date | 02/24/2026
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Provider Practice Location Address
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Address Line | 21273 26TH AVE
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City | BAYSIDE
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State | NY
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Zip | 11360-1943
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Country | US
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Telephone | 516-345-4262
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Fax |
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Provider Business Mailing Address
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Address Line | 5338 65TH PL
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City | MASPETH
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State | NY
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Zip | 11378-1654
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Country | US
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Telephone | 661-993-3159
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 015185
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License Number State | NY
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