Provider Demographics
NPI:1154119089
Name:MAPANAO, INGEMAR MANARIN (PT)
Entity type:Individual
Prefix:
First Name:INGEMAR
Middle Name:MANARIN
Last Name:MAPANAO
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:INGEMAR
Other - Middle Name:MANARIN
Other - Last Name:MAPANAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:118 CARLETON AVE APT 7A
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-2638
Mailing Address - Country:US
Mailing Address - Phone:631-877-9117
Mailing Address - Fax:631-877-9117
Practice Address - Street 1:118 CARLETON AVE APT 7A
Practice Address - Street 2:
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-2638
Practice Address - Country:US
Practice Address - Phone:631-877-9117
Practice Address - Fax:631-877-9117
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053031225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist