Provider Demographics
NPI:1306590187
Name:GITALAN, EIDILEEN (PT)
Entity type:Individual
Prefix:MISS
First Name:EIDILEEN
Middle Name:
Last Name:GITALAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:EIDILEEN
Other - Middle Name:
Other - Last Name:GITALAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:8524 110TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1244
Mailing Address - Country:US
Mailing Address - Phone:347-819-1160
Mailing Address - Fax:
Practice Address - Street 1:8524 110TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1244
Practice Address - Country:US
Practice Address - Phone:347-819-1160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024236-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist