Healthcare Provider Details

I. General information

NPI: 1609140995
Provider Name (Legal Business Name): EXCELSIOR PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2012
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E 58TH ST 15TH FLOOR
NEW YORK NY
10022-1236
US

IV. Provider business mailing address

133 E 58TH ST 15TH FLOOR
NEW YORK NY
10022-1236
US

V. Phone/Fax

Practice location:
  • Phone: 212-751-8300
  • Fax: 212-813-9455
Mailing address:
  • Phone: 212-751-8300
  • Fax: 212-813-9455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number8699-1
License Number StateNY

VIII. Authorized Official

Name: MR. FRANK A D'ELIA
Title or Position: PRESIDENT
Credential: P.T.
Phone: 212-751-8300