Healthcare Provider Details

I. General information

NPI: 1649279019
Provider Name (Legal Business Name): WHITESTONE PHYSICAL THERAPY OF QUEENS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15012 14TH AVE LL1
WHITESTONE NY
11357-1800
US

IV. Provider business mailing address

15012 14TH AVE LL1
WHITESTONE NY
11357-1800
US

V. Phone/Fax

Practice location:
  • Phone: 718-746-8757
  • Fax: 718-746-3069
Mailing address:
  • Phone: 718-746-8757
  • Fax: 718-746-3069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number012082-1
License Number StateNY

VIII. Authorized Official

Name: MR. FELIX ROBERT DIAZ
Title or Position: PRESIDENT
Credential: P.T.
Phone: 718-746-8757