Provider Demographics
NPI:1346246923
Name:PHYSICAL THERAPY ASSOCIATE OF BROOKLYN
Entity Type:Organization
Organization Name:PHYSICAL THERAPY ASSOCIATE OF BROOKLYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MORDECHAI
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHEDROWITZKY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-616-1450
Mailing Address - Street 1:2072 OCEAN AVE
Mailing Address - Street 2:APT 101
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7380
Mailing Address - Country:US
Mailing Address - Phone:718-616-1450
Mailing Address - Fax:718-743-8186
Practice Address - Street 1:2072 OCEAN AVE
Practice Address - Street 2:APT 101
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7380
Practice Address - Country:US
Practice Address - Phone:718-616-1450
Practice Address - Fax:718-743-8186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023536225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6698335OtherGHI
NY02351206Medicaid
NYP00100706OtherRAILROAD MEDICARE
NY171942OtherELDERPLAN
NYQ2W1F1Medicare ID - Type Unspecified
NY4987860001Medicare NSC