Healthcare Provider Details

I. General information

NPI: 1508876293
Provider Name (Legal Business Name): ADVANTAGE PHYSICAL THERAPY AT BROOKVIEW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 COLUMBIA TPKE STE 2
EAST GREENBUSH NY
12061
US

IV. Provider business mailing address

568 COLUMBIA TPKE STE 2
EAST GREENBUSH NY
12061
US

V. Phone/Fax

Practice location:
  • Phone: 518-477-6179
  • Fax: 518-477-6209
Mailing address:
  • Phone: 518-477-6179
  • Fax: 518-477-6209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN W FORNABAIO JR.
Title or Position: PRESIDENT PHYSICAL THERAPIST
Credential: PT CSCS
Phone: 518-477-6179