Provider Demographics
NPI:1013219047
Name:PROCORE PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:PROCORE PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEMKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:845-268-7800
Mailing Address - Street 1:612 CORPORATE WAY
Mailing Address - Street 2:SUITE 7
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2021
Mailing Address - Country:US
Mailing Address - Phone:845-268-7800
Mailing Address - Fax:845-268-5037
Practice Address - Street 1:430 NANUET MALL S
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2710
Practice Address - Country:US
Practice Address - Phone:845-589-0556
Practice Address - Fax:845-589-0558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018525-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy