Basic Information
| Provider Information | |||||||||
| NPI: | 1003803727 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KALANGIE | ||||||||
| FirstName: | JOE | ||||||||
| MiddleName: | FRANCIS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 355 OVINGTON AVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112091483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187484747 | ||||||||
| FaxNumber: | 7189214402 | ||||||||
| Practice Location | |||||||||
| Address1: | 355 OVINGTON AVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112091483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187484747 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 123125 | NY | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 00743444 | 05 | NY | MEDICAID |