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General NPI Number Information
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NPI Number | 1356675144
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Entity Type | Individual
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Provider Name | MR. JUSTIN L ETTINGER
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Gender | Male
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Dates
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Enumeration Date | 09/25/2009
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Last Update Date | 09/25/2009
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Provider Practice Location Address
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Address Line | 508 W 26TH ST 10 FLOOR
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City | NEW YORK
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State | NY
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Zip | 10001-5504
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Country | US
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Telephone | 646-230-9292
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Fax | 646-230-9133
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Provider Business Mailing Address
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Address Line | 508 W 26TH ST 10 FLOOR
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City | NEW YORK
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State | NY
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Zip | 10001-5504
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Country | US
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Telephone | 646-230-9292
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Fax | 646-230-9133
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 026037-1
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License Number State | NY
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