Provider Demographics
NPI:1558435172
Name:PALCONET, GINA (PT)
Entity type:Individual
Prefix:MISS
First Name:GINA
Middle Name:
Last Name:PALCONET
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4720
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-8720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:78 CYPRESS RD STE 4
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6815
Practice Address - Country:US
Practice Address - Phone:845-294-3484
Practice Address - Fax:845-294-3483
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019732225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6606566OtherGHI PPO
NY90220OtherGHI HMO
NY000499407002OtherHEALTHNOW
NY43993OtherMVP
NY1000031188OtherAFFINITY
NY2330866OtherUNITED HEALTHCARE
NY299647OtherWELLCARE
NYQ18N51OtherBCBS-NY
NYQQ1371Medicare PIN