Healthcare Provider Details

I. General information

NPI: 1467693986
Provider Name (Legal Business Name): EASTSIDE REHAB PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 06/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E 73RD ST SUITE 1B
NEW YORK NY
10021-3653
US

IV. Provider business mailing address

215 E 73RD ST SUITE 1B
NEW YORK NY
10021-3653
US

V. Phone/Fax

Practice location:
  • Phone: 212-717-8330
  • Fax: 212-717-6235
Mailing address:
  • Phone: 212-717-8330
  • Fax: 212-717-6235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number018149
License Number StateNY

VIII. Authorized Official

Name: DR. ALEX GOMEZ
Title or Position: PRESIDENT
Credential: DPT
Phone: 212-717-8330