Provider Demographics
NPI:1225088404
Name:ESBO MANAGEMENT PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:ESBO MANAGEMENT PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SEIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS
Authorized Official - Phone:917-519-1351
Mailing Address - Street 1:243 8TH ST APT 4R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-7229
Mailing Address - Country:US
Mailing Address - Phone:917-519-1351
Mailing Address - Fax:
Practice Address - Street 1:243 8TH ST APT 4R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-7229
Practice Address - Country:US
Practice Address - Phone:917-519-1351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQN6911Medicare ID - Type Unspecified