Healthcare Provider Details

I. General information

NPI: 1083746234
Provider Name (Legal Business Name): JAMES JOSEPH PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PARK AVE
NEW YORK NY
10166-0005
US

IV. Provider business mailing address

3610 DITMARS BLVD
ASTORIA NY
11105-1919
US

V. Phone/Fax

Practice location:
  • Phone: 212-953-9494
  • Fax: 212-682-2013
Mailing address:
  • Phone: 516-263-5596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number026792
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: