Provider Demographics
NPI:1003098138
Name:SPORTSCARE PHYSICAL THERAPY OF NY, P.C.
Entity Type:Organization
Organization Name:SPORTSCARE PHYSICAL THERAPY OF NY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANTIGUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-887-9000
Mailing Address - Street 1:11 EAGLE ROCK AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3101
Mailing Address - Country:US
Mailing Address - Phone:973-887-9000
Mailing Address - Fax:973-887-3654
Practice Address - Street 1:2 CROSFIELD AVE STE 101
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2233
Practice Address - Country:US
Practice Address - Phone:845-358-8989
Practice Address - Fax:845-358-8985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016861-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty