Provider Demographics
NPI:1558310458
Name:IBALE, GOLDA (RPT)
Entity type:Individual
Prefix:
First Name:GOLDA
Middle Name:
Last Name:IBALE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8314 54TH AVE
Mailing Address - Street 2:2F
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4714
Mailing Address - Country:US
Mailing Address - Phone:718-606-1315
Mailing Address - Fax:
Practice Address - Street 1:250 BEACH 17TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4420
Practice Address - Country:US
Practice Address - Phone:718-471-7500
Practice Address - Fax:718-327-5506
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026789225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist