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General NPI Number Information
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NPI Number | 1679997811
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Entity Type | Organization
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Legal Business Name | VILLAGE PHYSICAL THERAPY, CHIROPRACTIC&ACUPUNCTURE, PLLC
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Dates
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Enumeration Date | 02/07/2014
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Last Update Date | 06/30/2021
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Provider Practice Location Address
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Address Line | 6135 WOODHAVEN BLVD
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City | REGO PARK
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State | NY
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Zip | 11374-2739
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Country | US
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Telephone | 718-429-6630
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Fax | 718-429-6584
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Provider Business Mailing Address
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Address Line | 6133 WOODHAVEN BLVD
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City | REGO PARK
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State | NY
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Zip | 11374-2739
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Country | US
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Telephone | 718-429-6630
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Fax | 718-429-6584
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | FREDERICK GIOVANELLI
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Credential | DC
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Telephone | 718-429-6630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 003238
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 007331
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 018233
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License Number State | NY
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