Healthcare Provider Details

I. General information

NPI: 1124943857
Provider Name (Legal Business Name): GREENPORT PT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 FOSTER AVE LOWR LEVEL
BROOKLYN NY
11230-1304
US

IV. Provider business mailing address

35 GREENPORT ST
STATEN ISLAND NY
10304-3011
US

V. Phone/Fax

Practice location:
  • Phone: 347-705-0393
  • Fax:
Mailing address:
  • Phone:
  • 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: MAGGIE ELMARDENLY
Title or Position: PRESIDENT
Credential: DPT
Phone: 347-755-6686