Provider Demographics
NPI:1073903084
Name:PERFORMANCE PHYSICAL THERAPY OF NEW YORK PLLC
Entity Type:Organization
Organization Name:PERFORMANCE PHYSICAL THERAPY OF NEW YORK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-264-6983
Mailing Address - Street 1:333 POST RD W
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-4701
Mailing Address - Country:US
Mailing Address - Phone:203-422-0679
Mailing Address - Fax:
Practice Address - Street 1:115 W 45TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4005
Practice Address - Country:US
Practice Address - Phone:212-300-5545
Practice Address - Fax:212-300-5495
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERFORMANCE HEALTH CARE MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty