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General NPI Number Information
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NPI Number | 1700181807
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Entity Type | Organization
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Legal Business Name | A NEW STRIDE P T S L P THERAPEUTIC SERVICES PLLC
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Dates
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Enumeration Date | 01/20/2011
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Last Update Date | 01/20/2011
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Provider Practice Location Address
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Address Line | 1779 RICHMOND AVE FL 3
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City | STATEN ISLAND
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State | NY
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Zip | 10314-3907
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Country | US
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Telephone | 718-494-5923
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Fax |
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Provider Business Mailing Address
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Address Line | 1779 RICHMOND AVE FL 3
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City | STATEN ISLAND
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State | NY
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Zip | 10314-3907
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Country | US
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Telephone | 718-494-5923
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | GEORGE JOHN NICKEL
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Credential | CCC-SLP
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Telephone | 718-494-5923
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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