=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598833220
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PULMONARY WELLNESS REHABILITATION PTPC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22 W 38TH ST 4TH FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10018-6262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-921-0214
-----------------------------------------------------
Fax | 212-921-0217
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22 W 38TH ST 4TH FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10018-6262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-921-0214
-----------------------------------------------------
Fax | 212-921-0217
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM DIRECTOR
-----------------------------------------------------
Name | DR. NOAH GREENSPAN
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 212-921-0214
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 012954
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------