Healthcare Provider Details

I. General information

NPI: 1265549885
Provider Name (Legal Business Name): GRAND CENTRAL PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 LEXINGTON AVE SUITE #233
NEW YORK NY
10170-0002
US

IV. Provider business mailing address

420 LEXINGTON AVE SUITE #233
NEW YORK NY
10170-0002
US

V. Phone/Fax

Practice location:
  • Phone: 212-697-3438
  • Fax: 212-697-5983
Mailing address:
  • Phone: 212-697-3438
  • Fax: 212-697-5983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number010604
License Number StateNY

VIII. Authorized Official

Name: ROBERT ORTIZ
Title or Position: PRESIDENT
Credential: P. T.
Phone: 212-697-3438