Provider Demographics
NPI:1144780990
Name:NEW YORK FITNESS PROFESSIONALS
Entity Type:Organization
Organization Name:NEW YORK FITNESS PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUI
Authorized Official - Middle Name:
Authorized Official - Last Name:MATEUS
Authorized Official - Suffix:
Authorized Official - Credentials:MES,MEPD
Authorized Official - Phone:646-420-2569
Mailing Address - Street 1:175 MEMORIAL HWY STE LL1
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5642
Mailing Address - Country:US
Mailing Address - Phone:646-420-2569
Mailing Address - Fax:
Practice Address - Street 1:175 MEMORIAL HWY STE LL1
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5642
Practice Address - Country:US
Practice Address - Phone:646-420-2569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation