=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912274804
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FISHBEIN PHYSICAL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2011
-----------------------------------------------------
Last Update Date | 11/21/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 151 E 19TH ST 2ND FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10003-2469
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-463-8338
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 615 FORT WASHINGTON AVE APT. 3B
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10040-3954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, PRESIDENT
-----------------------------------------------------
Name | ELLIOT D FISHBEIN
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 917-846-7210
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 022212
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------