Healthcare Provider Details

I. General information

NPI: 1538460126
Provider Name (Legal Business Name): ETERNITY PHYSICAL THERAPY PC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BROADWAY SUITE 1302
NEW YORK NY
10038
US

IV. Provider business mailing address

150 BROADWAY SUITE 1302
NEW YORK NY
10038
US

V. Phone/Fax

Practice location:
  • Phone: 212-785-1651
  • Fax:
Mailing address:
  • Phone: 212-785-1651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number031590
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: DR. DARLENZY DARBOUZE
Title or Position: CEO
Credential: D.P.T
Phone: 917-977-1550