Healthcare Provider Details

I. General information

NPI: 1972892446
Provider Name (Legal Business Name): NYSSPT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1829 HOBART AVE
BRONX NY
10461-4117
US

IV. Provider business mailing address

1829 HOBART AVE
BRONX NY
10461-4117
US

V. Phone/Fax

Practice location:
  • Phone: 347-810-7637
  • Fax: 347-810-7638
Mailing address:
  • Phone: 347-810-7637
  • Fax: 347-810-7638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number026668-1
License Number StateNY

VIII. Authorized Official

Name: DR. KARN SANTIKUL
Title or Position: PRESIDENT
Credential: DPT
Phone: 347-810-7637