Kalpana Balasubramanian, PHYSICAL THERAPIST
Individual provider Active NPI Physical Therapist · Freeport, NY
NPI 1003963935 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1003963935
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 021278 (NY)
- Practice address
- 101 S Bergen PL
Freeport, NY 11520-3528 - Phone
- (516) 623-3600
- Fax
- (516) 623-9191
- NPI assigned
- Jan 4, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221216001844 | NY | Practitioner - Physical Therapist in Private Practice | 7113396946 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021278 | NY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of New York Comptrollers Office | Current |
Accepting new patients |
Locations
44 Holland Ave
Fl 4
Albany, NY 12208
81 Mall Dr
Commack, NY 11725
Phone (631) 326-4428
8045 Winchester Blvd
Bldg 80
Queens Village, NY 11427
Phone (718) 217-4242
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 021278 | NY | Yes |
Addresses
Primary practice location
101 S Bergen PL
Freeport, NY 11520-3528
Mailing address
25 Avalon Rd
Hewlett, NY 11557-1401
Phone (516) 837-0356
NPI Registry JSON
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003963935",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 AVALON RD",
"city": "HEWLETT",
"state": "NY",
"postal_code": "115571401",
"telephone_number": "516-837-0356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 S BERGEN PL",
"city": "FREEPORT",
"state": "NY",
"postal_code": "115203528",
"telephone_number": "516-623-3600",
"fax_number": "516-623-9191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALASUBRAMANIAN",
"first_name": "KALPANA",
"credential": "PHYSICAL THERAPIST",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "021278",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Freeport, NY
- Crispin Zapanta Ayroso
- B Emotionally Fit LLC
- Shaffeeulah Bacchus
- Monique Nichole Bailey-Rushdan
- Baksolutions
- Stephanie Baril
- Hyacinth Patrica Barnwell
- Delores Baronette
- Shameeka Baston
- Patricia Batus
All providers in Freeport, NY · Physical Therapist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.