Provider Demographics
NPI:1285478651
Name:TAN, RODEL ABLIN (PT, DPT)
Entity type:Individual
Prefix:
First Name:RODEL
Middle Name:ABLIN
Last Name:TAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 FIVE OAKS LN
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-1634
Mailing Address - Country:US
Mailing Address - Phone:917-421-2372
Mailing Address - Fax:
Practice Address - Street 1:845 PALMER AVE
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-2406
Practice Address - Country:US
Practice Address - Phone:917-421-2372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist