=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417179763
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NY PHYSICAL THERAPY & WELLNESS, EAST MEADOW, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2007
-----------------------------------------------------
Last Update Date | 12/18/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 325 MERRICK AVE
-----------------------------------------------------
City | EAST MEADOW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11554-1556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-222-2455
-----------------------------------------------------
Fax | 516-222-2459
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2088 FRONT STREET
-----------------------------------------------------
City | EAST MEADOW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-222-2455
-----------------------------------------------------
Fax | 516-222-2459
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR PHYSICAL THERAPIST
-----------------------------------------------------
Name | MR. MATTHEW PERRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-222-2455
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 025872-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------