Healthcare Provider Details

I. General information

NPI: 1235218132
Provider Name (Legal Business Name): ATHALON PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 E 74TH ST STE 3
NEW YORK NY
10021-3235
US

IV. Provider business mailing address

159 E 74TH ST STE 3
NEW YORK NY
10021-3235
US

V. Phone/Fax

Practice location:
  • Phone: 212-838-8023
  • Fax: 212-838-8027
Mailing address:
  • Phone: 212-838-8023
  • Fax: 212-838-8027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number022325
License Number StateNY

VIII. Authorized Official

Name: MR. JASON KLEIN
Title or Position: PRESIDENT
Credential: PT
Phone: 212-838-8023