Healthcare Provider Details

I. General information

NPI: 1497978522
Provider Name (Legal Business Name): FLEXICARE PT SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 NEPTUNE AVE
BROOKLYN NY
11235-6845
US

IV. Provider business mailing address

5852 43RD AVE APT# 2R
WOODSIDE NY
11377-4852
US

V. Phone/Fax

Practice location:
  • Phone: 718-615-0800
  • Fax: 866-419-7618
Mailing address:
  • Phone: 718-305-2173
  • Fax: 718-305-2173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number024082-1
License Number StateNY

VIII. Authorized Official

Name: MRS. IRENE MARIANO LAZCANO
Title or Position: OWNER
Credential: PT
Phone: 718-615-0800