Healthcare Provider Details

I. General information

NPI: 1790754661
Provider Name (Legal Business Name): JACK MARCHESCHI PHYSICAL THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WORLD FINANCIAL CTR
NEW YORK NY
10281-1008
US

IV. Provider business mailing address

75 MAIDEN LN SUITE 801
NEW YORK NY
10038-4810
US

V. Phone/Fax

Practice location:
  • Phone: 646-312-6221
  • Fax: 212-269-2905
Mailing address:
  • Phone: 646-312-6221
  • Fax: 212-269-2905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number006615-1
License Number StateNY

VIII. Authorized Official

Name: MR. JACK ANTHONY MARCHESCHI
Title or Position: PRESIDENT
Credential: P.T.
Phone: 646-312-6221