Basic Information
| Provider Information | |||||||||
| NPI: | 1346578754 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAN | ||||||||
| FirstName: | CARLO | ||||||||
| MiddleName: | PONTI | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 207 W 79TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100246283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128741550 | ||||||||
| FaxNumber: | 2128741599 | ||||||||
| Practice Location | |||||||||
| Address1: | 248 W 80TH ST | ||||||||
| Address2: | 5TH FL | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100247608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128741550 | ||||||||
| FaxNumber: | 2128741599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2009 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 0-30011 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.