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General NPI Number Information
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NPI Number | 1962883900
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Entity Type | Organization
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Legal Business Name | MEDISPA ONE NY PLAZA LLC
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Dates
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Enumeration Date | 06/16/2015
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Last Update Date | 11/01/2016
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Provider Practice Location Address
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Address Line | 1 NEW YORK PLZ CONCOURSE LEVEL, WHITEHALL STREET
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City | NEW YORK
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State | NY
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Zip | 10004-1901
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Country | US
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Telephone | 646-918-6883
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Fax | 646-737-6883
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Provider Business Mailing Address
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Address Line | 1 NEW YORK PLZ CONCOURSE LEVEL, WHITEHALL STREET
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City | NEW YORK
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State | NY
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Zip | 10004-1901
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Country | US
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Telephone | 646-918-6883
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Fax | 646-737-6883
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Authorized Official
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Title or Position | MANAGING MEMBER/CEO
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Name | RICHARD SANSARICQ
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Credential |
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Telephone | 917-907-1546
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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 |
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License Number State |
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