Provider Demographics
NPI:1689908907
Name:PENALBA, MAY PEGOLLO (PT)
Entity type:Individual
Prefix:MS
First Name:MAY
Middle Name:PEGOLLO
Last Name:PENALBA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:53 HAZEN CT APT A
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3214
Mailing Address - Country:US
Mailing Address - Phone:516-477-4471
Mailing Address - Fax:
Practice Address - Street 1:156 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-2609
Practice Address - Country:US
Practice Address - Phone:646-858-0138
Practice Address - Fax:646-858-0196
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030948-01225100000X
NY030948-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist