=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548344187
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAROLD ROSENTHAL, P.T., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2121 BROADWAY SUITE 404
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10023-1786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-304-4467
-----------------------------------------------------
Fax | 212-304-0814
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 77 PARK TER E #D56 & 66
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10034-1453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-304-4467
-----------------------------------------------------
Fax | 212-304-0814
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. HAROLD ROSENTHAL
-----------------------------------------------------
Credential | P.T.
-----------------------------------------------------
Telephone | 212-304-4467
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 88401
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------