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General NPI Number Information
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NPI Number | 1073764262
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Entity Type | Organization
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Legal Business Name | PRIME PHYSICAL THERAPY & REHABILITATION PC
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Dates
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Enumeration Date | 10/06/2008
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Last Update Date | 10/06/2008
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Provider Practice Location Address
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Address Line | 22 W 21ST ST STE 404
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City | NEW YORK
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State | NY
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Zip | 10010-6936
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Country | US
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Telephone | 718-304-4898
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Fax |
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Provider Business Mailing Address
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Address Line | 22 W 21ST ST STE 404
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City | NEW YORK
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State | NY
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Zip | 10010-6936
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | STANLEY GAVRIEL
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Credential | D.P.T.
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Telephone | 718-304-4898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 029384
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License Number State | NY
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