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General NPI Number Information
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NPI Number | 1699969220
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Entity Type | Organization
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Legal Business Name | STATE OF THE ART PHYSICAL THERAPY REHABILITATION,P.C.
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Dates
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Enumeration Date | 08/27/2007
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 173 FREEMAN AVE
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City | ELMONT
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State | NY
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Zip | 11003-4906
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Country | US
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Telephone | 516-993-0977
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Fax |
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Provider Business Mailing Address
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Address Line | 173 FREEMAN AVE
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City | ELMONT
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State | NY
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Zip | 11003-4906
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Country | US
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Telephone | 516-993-0977
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. EMILIAN IFEOMA EMEAGWALI
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Credential | D.P.T.
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Telephone | 516-993-0977
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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 | 0289721
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License Number State | NY
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