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General NPI Number Information
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NPI Number | 1578602934
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Entity Type | Organization
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Legal Business Name | STATEN ISLAND PHYSCIAL THERAPY PC
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 4906 ARTHUR KILL RD
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City | STATEN ISLAND
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State | NY
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Zip | 10309-2601
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Country | US
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Telephone | 718-317-2006
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Fax | 718-317-2016
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Provider Business Mailing Address
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Address Line | 4906 ARTHUR KILL RD
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City | STATEN ISLAND
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State | NY
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Zip | 10309-2601
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Country | US
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Telephone | 718-317-2006
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Fax | 718-317-2016
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Authorized Official
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Title or Position | PHYSICAL THERAPIST OWNER
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Name | MR. BARRY J GOLDMAN
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Credential | MS PT
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Telephone | 718-317-2006
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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 | 0252871
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0254831
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License Number State | NY
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