MEDICARE: SNYS PHYSICAL THERAPY LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number
1	251E00000X	Home Health Agency
2	261QA0006X	Ambulatory Fertility Facility	010909
3	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1750815593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SNYS PHYSICAL THERAPY LLC.

Provider Business Mailing Address
First Line	:	172 PALISADE AVE
Second Line	:
City	:	BOGOTA
State	:	NJ
Zip	:	07603-1634
Country	:	US
Telephone Number	:	845-527-8008
Fax Number	:	201-820-4365

Provider Business Practice Location Address
First Line	:	629 WEST 185TH STREET
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-1634
Country	:	US
Telephone Number	:	845-527-8008
Fax Number	:	201-820-4365

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SAMIR AZIZ
Credential	:	DPT
Telephone Number	:	845-527-8008

Provider Enumeration Date	:	04/19/2017
Last Update Date	:	04/19/2017

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