Provider Demographics
NPI:1043394422
Name:PERFORMANCE OCCUPATIONAL & PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:PERFORMANCE OCCUPATIONAL & PHYSICAL THERAPY, PLLC
Other - Org Name:PERFORMANCE HAND THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:IANNELLO
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:212-604-1316
Mailing Address - Street 1:95 UNIVERSITY PL
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4515
Mailing Address - Country:US
Mailing Address - Phone:212-604-1316
Mailing Address - Fax:212-604-1320
Practice Address - Street 1:95 UNIVERSITY PL
Practice Address - Street 2:8TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4515
Practice Address - Country:US
Practice Address - Phone:212-604-1316
Practice Address - Fax:212-604-1320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5813750001Medicare NSC
NYQAWQX1Medicare PIN