Provider Demographics
NPI:1083744874
Name:PALESTIS, PAUL E (PT OCS)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:E
Last Name:PALESTIS
Suffix:
Gender:M
Credentials:PT OCS
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Mailing Address - Street 1:1015 SAW MILL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1118
Mailing Address - Country:US
Mailing Address - Phone:914-400-1500
Mailing Address - Fax:914-400-1500
Practice Address - Street 1:1727 BROADWAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5214
Practice Address - Country:US
Practice Address - Phone:212-765-4800
Practice Address - Fax:212-765-4855
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019075-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ08P21Medicare ID - Type Unspecified