Individual provider Active NPI

Benjamin Calma Manalac, BSPT

  • Physical Therapist
  • Maspeth, NY
National Provider Identifier
1164736757
Registry record updated Aug 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
031334 Issued in NY
Practice address
6918 59TH Rd
Maspeth, NY 11378-2920
Phone
(646) 623-9511
NPI assigned
Aug 5, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 5, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 031334 NY Primary

Addresses

Primary practice location

6918 59TH Rd
Maspeth, NY 11378-2920

Mailing address

6918 59TH Rd
Maspeth, NY 11378-2920
Phone (646) 623-9511

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191007000829 NY Practitioner - Physical Therapist in Private Practice 3072844018 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
031334NYMDPhysical Therapist

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1280966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280966400000",
    "number": "1164736757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6918 59TH RD",
            "city": "MASPETH",
            "state": "NY",
            "postal_code": "113782920",
            "telephone_number": "646-623-9511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6918 59TH RD",
            "city": "MASPETH",
            "state": "NY",
            "postal_code": "113782920",
            "telephone_number": "646-623-9511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANALAC",
        "first_name": "BENJAMIN",
        "middle_name": "CALMA",
        "name_prefix": "Mr.",
        "credential": "BSPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-08-05",
        "last_updated": "2010-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "031334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maspeth, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.