Healthcare Provider Details

I. General information

NPI: 1720721616
Provider Name (Legal Business Name): CARLY B GEFFNER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 FORT WASHINGTON AVE
NEW YORK NY
10032-3729
US

IV. Provider business mailing address

161 FORT WASHINGTON AVE
NEW YORK NY
10032-3729
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-8225
  • Fax:
Mailing address:
  • Phone: 212-305-8225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number048523-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: