Provider Demographics
NPI:1093788135
Name:EAST SIDE SPORTS PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:EAST SIDE SPORTS PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SARANITI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:212-570-0209
Mailing Address - Street 1:244 E 84TH ST
Mailing Address - Street 2:3 FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2902
Mailing Address - Country:US
Mailing Address - Phone:212-570-0209
Mailing Address - Fax:212-570-0197
Practice Address - Street 1:244 E 84TH ST
Practice Address - Street 2:3 FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2902
Practice Address - Country:US
Practice Address - Phone:212-570-0209
Practice Address - Fax:212-570-0197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005564261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ2WTT1Medicare ID - Type UnspecifiedPHYSICAL THERAPY OFFICE