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General NPI Number Information
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NPI Number | 1548046139
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Entity Type | Organization
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Legal Business Name | CROSS ISLAND PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 09/07/2023
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 194 COVERT AVE
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City | FLORAL PARK
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State | NY
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Zip | 11001-3741
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Country | US
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Telephone | 847-852-0894
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Fax |
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Provider Business Mailing Address
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Address Line | 194 COVERT AVE
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City | FLORAL PARK
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State | NY
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Zip | 11001-3741
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Country | US
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Telephone | 847-852-0894
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MELWIN FERNANDEZ
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Credential | DPT
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Telephone | 847-852-0894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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