Healthcare Provider Details

I. General information

NPI: 1467826602
Provider Name (Legal Business Name): 200 BROADWAY PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2015
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S BROADWAY STE 2-2
TARRYTOWN NY
10591-4500
US

IV. Provider business mailing address

200 S BROADWAY STE 2-2
TARRYTOWN NY
10591-4500
US

V. Phone/Fax

Practice location:
  • Phone: 914-631-1919
  • Fax: 914-631-1943
Mailing address:
  • Phone: 914-631-1919
  • Fax: 914-631-1943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number027552
License Number StateNY

VIII. Authorized Official

Name: MR. FARHAD ROSTAMI
Title or Position: DIRECTOR
Credential: PT
Phone: 914-631-1919