Healthcare Provider Details

I. General information

NPI: 1538223219
Provider Name (Legal Business Name): DAVID M ENDRES MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E 56TH ST SUITE 1010
NEW YORK NY
10022-3607
US

IV. Provider business mailing address

22 W 77TH ST APT 46
NEW YORK NY
10024-5151
US

V. Phone/Fax

Practice location:
  • Phone: 212-759-2211
  • Fax: 212-829-1189
Mailing address:
  • Phone: 917-601-5558
  • Fax: 212-829-1189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number017646
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: