MEDICARE: NEW YORK SOCIETY FOR THE RELIEF OF RUPTURED & CRIPPLED MAINTAINING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1083079925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW YORK SOCIETY FOR THE RELIEF OF RUPTURED & CRIPPLED MAINTAINING

Provider Business Mailing Address
First Line	:	535 E 70TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-4823
Country	:	US
Telephone Number	:	212-606-1239
Fax Number	:

Provider Business Practice Location Address
First Line	:	270 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-2014
Country	:	US
Telephone Number	:	212-552-4101
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE V.P. & CFO
Name	:	STACEY MALAKOFF
Credential	:
Telephone Number	:	212-606-1239

Provider Enumeration Date	:	12/18/2015
Last Update Date	:	12/19/2018

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