Healthcare Provider Details

I. General information

NPI: 1063045276
Provider Name (Legal Business Name): ANTHONY TAKYAN LING PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2020
Last Update Date: 02/16/2020
Certification Date: 02/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 E 84TH ST FL 2
NEW YORK NY
10028-2029
US

IV. Provider business mailing address

1949 82ND ST
BROOKLYN NY
11214-2305
US

V. Phone/Fax

Practice location:
  • Phone: 212-327-0600
  • Fax:
Mailing address:
  • Phone: 808-381-6877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number044871-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: