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General NPI Number Information
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NPI Number | 1689904807
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Entity Type | Organization
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Legal Business Name | PARADIGM PHYSICAL THERAPY, P.C.
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 01/11/2010
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Provider Practice Location Address
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Address Line | 1556 3RD AVE SUITE 211
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City | NEW YORK
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State | NY
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Zip | 10128-3100
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Country | US
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Telephone | 201-780-9691
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Fax |
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Provider Business Mailing Address
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Address Line | 5 VALLEY RD
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City | ALLENDALE
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State | NJ
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Zip | 07401-1435
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Country | US
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Telephone | 201-780-9691
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUSTIN B GORNELL
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Credential | PT, DPT, OCS
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Telephone | 201-780-9691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 024310
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License Number State | NY
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