Provider Demographics
NPI:1285856898
Name:ERGO PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:ERGO PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSAB
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:718-261-3100
Mailing Address - Street 1:10740 QUEENS BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4252
Mailing Address - Country:US
Mailing Address - Phone:718-261-3100
Mailing Address - Fax:718-261-2915
Practice Address - Street 1:10740 QUEENS BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4252
Practice Address - Country:US
Practice Address - Phone:718-261-3100
Practice Address - Fax:718-261-2915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07476Medicare PIN