Provider Demographics
NPI:1093941874
Name:SUPERIOR PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:SUPERIOR PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KREISLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-880-6390
Mailing Address - Street 1:8648 MARENGO ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1326
Mailing Address - Country:US
Mailing Address - Phone:917-880-6390
Mailing Address - Fax:718-776-8975
Practice Address - Street 1:8648 MARENGO ST
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-1326
Practice Address - Country:US
Practice Address - Phone:917-880-6390
Practice Address - Fax:718-776-8975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-07
Last Update Date:2009-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008309-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty