1578602934 NPI number — STATEN ISLAND PHYSCIAL THERAPY PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578602934 NPI number — STATEN ISLAND PHYSCIAL THERAPY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STATEN ISLAND PHYSCIAL THERAPY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578602934
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4906 ARTHUR KILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10309-2601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-317-2006
Provider Business Mailing Address Fax Number:
718-317-2016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4906 ARTHUR KILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10309-2601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-317-2006
Provider Business Practice Location Address Fax Number:
718-317-2016
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDMAN
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PHYSICAL THERAPIST OWNER
Authorized Official Telephone Number:
718-317-2006

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  0254831 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 0252871 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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