Healthcare Provider Details

I. General information

NPI: 1093788135
Provider Name (Legal Business Name): EAST SIDE SPORTS PHYSICAL THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 E 84TH ST 3 FLOOR
NEW YORK NY
10028-2902
US

IV. Provider business mailing address

244 E 84TH ST 3 FLOOR
NEW YORK NY
10028-2902
US

V. Phone/Fax

Practice location:
  • Phone: 212-570-0209
  • Fax: 212-570-0197
Mailing address:
  • Phone: 212-570-0209
  • Fax: 212-570-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number005564
License Number StateNY

VIII. Authorized Official

Name: MR. ANTHONY J SARANITI
Title or Position: PRESIDENT
Credential: P.T.
Phone: 212-570-0209