Provider Demographics
NPI:1073670220
Name:BROOKLYN PHYSICAL THERAPY SERVICES, PC
Entity Type:Organization
Organization Name:BROOKLYN PHYSICAL THERAPY SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACQUES
Authorized Official - Middle Name:C
Authorized Official - Last Name:AUGUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-788-2170
Mailing Address - Street 1:346 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1906
Mailing Address - Country:US
Mailing Address - Phone:718-788-2170
Mailing Address - Fax:718-788-2214
Practice Address - Street 1:346 1ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1906
Practice Address - Country:US
Practice Address - Phone:718-788-2170
Practice Address - Fax:718-788-2214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005845-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ53822Medicare PIN