Healthcare Provider Details

I. General information

NPI: 1265184998
Provider Name (Legal Business Name): FIFTH AVENUE PHYSICAL THERAPY AND WELLNESS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 AVENUE OF THE AMERICAS PARAMOUNT WELLNESS / CONCOURSE LEVEL
NEW YORK NY
10019-6022
US

IV. Provider business mailing address

1301 AVENUE OF THE AMERICAS PARAMOUNT WELLNESS / CONCOURSE LEVEL
NEW YORK NY
10019-6022
US

V. Phone/Fax

Practice location:
  • Phone: 347-507-5877
  • Fax: 347-507-5877
Mailing address:
  • Phone: 347-507-5877
  • Fax: 347-507-5877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SCOTT A WEISS
Title or Position: OWNER / PRINCIPAL
Credential: DPT ATC
Phone: 347-507-5877