Provider Demographics
NPI:1053661637
Name:IMPERIAL PHYSICAL THERAPY
Entity Type:Organization
Organization Name:IMPERIAL PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTLYARSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:917-270-6143
Mailing Address - Street 1:369 LEXINGTON AVENUE 16TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017
Mailing Address - Country:US
Mailing Address - Phone:646-861-1203
Mailing Address - Fax:212-943-1999
Practice Address - Street 1:369 LEXINGTON AVENUE 16TH FLOOR
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:646-861-1203
Practice Address - Fax:212-943-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty