Healthcare Provider Details

I. General information

NPI: 1386978237
Provider Name (Legal Business Name): JAMES KOBETITSCH P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 BRYANT AVE
NEW HYDE PARK NY
11040-2805
US

IV. Provider business mailing address

215 BRYANT AVE
NEW HYDE PARK NY
11040-2805
US

V. Phone/Fax

Practice location:
  • Phone: 516-437-8382
  • Fax: 516-270-3247
Mailing address:
  • Phone: 516-437-8382
  • Fax: 516-270-3247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007061-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: