=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134161839
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARK AVENUE PHYSICAL THERAPY SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 PARK AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-4348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-816-8925
-----------------------------------------------------
Fax | 201-816-8926
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 661 E PALISADE AVE
-----------------------------------------------------
City | ENGLEWOOD CLIFFS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07632-1800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-816-8925
-----------------------------------------------------
Fax | 201-816-8926
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DAVID GARBER
-----------------------------------------------------
Credential | P.T.
-----------------------------------------------------
Telephone | 201-816-8925
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 018283-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------