Healthcare Provider Details

I. General information

NPI: 1336572015
Provider Name (Legal Business Name): PROFESSIONAL ORTHOPEDIC AND SPORTS PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W 71ST ST
NEW YORK NY
10023-3766
US

IV. Provider business mailing address

576 BROADHOLLOW RD
MELVILLE NY
11747-5002
US

V. Phone/Fax

Practice location:
  • Phone: 212-799-0160
  • Fax: 212-799-0209
Mailing address:
  • Phone: 212-799-0160
  • Fax: 212-799-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. HELEN AGRELO
Title or Position: REGIONAL BUSINESS MANAGER
Credential:
Phone: 718-767-0610