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Balboa Pt

Physical Therapist

Respiratory, Developmental, Rehabilitative and Restorative Service Providers

945 Huguenot Ave, Staten Island, NY 10312-4312

(718) 816-6500

PECOS Enrollment

Based on the most recent information from CMS, provider Balboa Pt does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 34 days ago.

Profile Details

Provider ID
1811276876
Provider Type
Organization
Full Name
Balboa Pt

Subpart
No
Enumeration Date
8/9/2011
Last Updated
12/10/2014

Contact Information

Practice Location

945 Huguenot Ave, Staten Island, NY 10312-4312

(718) 816-6500

(718) 816-4677

Mailing Location

945 Huguenot Ave, Staten Island, NY 10312-4312

(718) 816-6500

(718) 816-4677

Authorized Official

Lamendola, Jason P (Physical Therapist)

(718) 816-6500

Provider Taxonomies

Code	Description	License
Code 225100000X Primary	Description Physical Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers	License 0205341 New York

Balboa Pt

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

Iyer, Kalpana K

Canlas, Albert

Yorio, Anthony

Leano, Remilee Escarilla

North Shore Pt Of Ny Pc

Virata, Emmanuel Valinton

Cregin, Julie Kristen

Pacchiano, Mark Anthony

Gardella, Michelle A

Cruz, Jose L