Provider Demographics
NPI:1023010352
Name:PRIORITY CARE PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:PRIORITY CARE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:GOODHEART
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-569-0373
Mailing Address - Street 1:11 FRANKLIN PL
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1216
Mailing Address - Country:US
Mailing Address - Phone:516-569-0373
Mailing Address - Fax:516-569-0374
Practice Address - Street 1:11 FRANKLIN PL
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1216
Practice Address - Country:US
Practice Address - Phone:516-569-0373
Practice Address - Fax:516-569-0374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013032-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQO4S91Medicare ID - Type UnspecifiedPHYSICAL THERAPY