Healthcare Provider Details

I. General information

NPI: 1174343313
Provider Name (Legal Business Name): INSPIRE CORE PT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 BROADWAY STE N
ALBANY NY
12207-2922
US

IV. Provider business mailing address

4131 219TH ST FL 1
BAYSIDE NY
11361-3541
US

V. Phone/Fax

Practice location:
  • Phone: 646-209-8764
  • Fax:
Mailing address:
  • Phone: 646-209-8764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN YIP SHING LAM
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 646-209-8764