Healthcare Provider Details

I. General information

NPI: 1669660270
Provider Name (Legal Business Name): HANDSON PHYSICAL THERAPY BAYSIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 FRANCIS LEWIS BLVD
BAYSIDE NY
11361-3002
US

IV. Provider business mailing address

4401 FRANCIS LEWIS BLVD
BAYSIDE NY
11361-3002
US

V. Phone/Fax

Practice location:
  • Phone: 718-224-2867
  • Fax: 718-224-3782
Mailing address:
  • Phone: 718-224-2867
  • Fax: 718-224-3782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number028321-1
License Number StateNY

VIII. Authorized Official

Name: DAVID CRUZ
Title or Position: CREDENTIALING MGR
Credential: BILLER
Phone: 718-707-6970