=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992075774
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLENN GOLDFINGER, PT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2012
-----------------------------------------------------
Last Update Date | 01/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 133 E 80TH ST STE 1
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10075-0317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-249-5485
-----------------------------------------------------
Fax | 212-249-5486
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 133 E 80TH ST STE 1
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10075-0317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-249-5485
-----------------------------------------------------
Fax | 212-249-5486
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. GLENN HARRIS GOLDFINGER
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 212-249-5485
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 2535
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------