Healthcare Provider Details

I. General information

NPI: 1437120987
Provider Name (Legal Business Name): NEW YORK PHYSICAL THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 S CENTRAL AVE
VALLEY STREAM NY
11580-5407
US

IV. Provider business mailing address

68 S CENTRAL AVE
VALLEY STREAM NY
11580-5407
US

V. Phone/Fax

Practice location:
  • Phone: 516-825-1112
  • Fax:
Mailing address:
  • Phone: 516-825-1112
  • Fax:

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: MR. EVAN A GREENE
Title or Position: ADMINISTRATOR
Credential: MSPT
Phone: 516-825-1112