MEDICARE: NEW U PHYSICAL THERAPY PLLC

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	261QP2000X	Physical Therapy Clinic/Center	028006	NY

General Provider Information

NPI Number	:	1184916835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW U PHYSICAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	1835 RICHMOND ROAD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306
Country	:	US
Telephone Number	:	718-502-5271
Fax Number	:	718-701-1188

Provider Business Practice Location Address
First Line	:	1835 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-2560
Country	:	US
Telephone Number	:	718-502-5271
Fax Number	:	718-701-1188

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. BORIS POLONSKIY
Credential	:	PT
Telephone Number	:	718-502-5271

Provider Enumeration Date	:	05/12/2011
Last Update Date	:	05/12/2011

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