Provider Demographics
NPI:1265025654
Name:MOMENTUM PHYSICAL THERAPY OF NEW YORK PLLC
Entity Type:Organization
Organization Name:MOMENTUM PHYSICAL THERAPY OF NEW YORK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKS
Authorized Official - Middle Name:
Authorized Official - Last Name:COMENO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:607-759-4035
Mailing Address - Street 1:318 SINGINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-2829
Mailing Address - Country:US
Mailing Address - Phone:607-759-4035
Mailing Address - Fax:
Practice Address - Street 1:318 SINGINGWOOD DR
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-2829
Practice Address - Country:US
Practice Address - Phone:607-759-4035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04328112Medicaid