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General NPI Number Information
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NPI Number | 1639431455
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Entity Type | Individual
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Provider Name | MADONNA TANDINGAN
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Gender | Female
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Dates
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Enumeration Date | 06/08/2012
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Last Update Date | 06/08/2012
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Provider Practice Location Address
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Address Line | 65 BROADWAY STE 906
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City | NEW YORK
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State | NY
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Zip | 10006-2530
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Country | US
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Telephone | 347-335-8536
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Fax | 516-385-2985
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Provider Business Mailing Address
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Address Line | 714 FOCH BLVD
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City | WILLISTON PK
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State | NY
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Zip | 11596-1010
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 031124
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License Number State | NY
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