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General NPI Number Information
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NPI Number | 1760659239
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Entity Type | Organization
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Legal Business Name | MALCAN PHYSICAL THERAPY, P.C.
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 5011 QUEENS BLVD BSMT
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City | WOODSIDE
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State | NY
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Zip | 11377-4469
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Country | US
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Telephone | 718-749-6838
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Fax | 718-343-2317
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Provider Business Mailing Address
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Address Line | 7805 270TH ST
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-1527
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Country | US
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Telephone | 718-749-6838
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Fax | 718-343-2317
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RAFAEL BUENAVENTURA DELA CRUZ
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Credential | P.T.
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Telephone | 718-749-6838
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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 | 017983-1
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License Number State | NY
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