Healthcare Provider Details

I. General information

NPI: 1710308846
Provider Name (Legal Business Name): STATEN ISLAND CENTER FOR ALTERNATIVE THERAPIES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2013
Last Update Date: 12/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 BLOOMINGDALE RD
STATEN ISLAND NY
10309-2061
US

IV. Provider business mailing address

520 BLOOMINGDALE RD
STATEN ISLAND NY
10309-2061
US

V. Phone/Fax

Practice location:
  • Phone: 718-605-1300
  • Fax: 718-605-8739
Mailing address:
  • Phone: 718-605-1300
  • Fax: 718-605-8739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: ALEKSEY KHOMENKO
Title or Position: PARTNER
Credential:
Phone: 718-605-1300