Provider Demographics
NPI:1346421104
Name:PRIME FITNESS PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:PRIME FITNESS PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAYNSHTOK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-676-4112
Mailing Address - Street 1:2952 BRIGHTON 3RD ST STE 202
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7078
Mailing Address - Country:US
Mailing Address - Phone:718-676-4112
Mailing Address - Fax:718-676-4134
Practice Address - Street 1:2952 BRIGHTON 3RD ST STE 202
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7078
Practice Address - Country:US
Practice Address - Phone:718-676-4112
Practice Address - Fax:718-676-4134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023330-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02936914Medicaid
NYW8Q891Medicare PIN