Provider Demographics
NPI:1346610730
Name:CORE BASICS PT PC
Entity Type:Organization
Organization Name:CORE BASICS PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LKALED
Authorized Official - Middle Name:
Authorized Official - Last Name:NASR
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:212-300-7069
Mailing Address - Street 1:1368 ACADEMY LN
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2112
Mailing Address - Country:US
Mailing Address - Phone:212-300-7069
Mailing Address - Fax:212-731-0267
Practice Address - Street 1:780 8TH AVE
Practice Address - Street 2:STE # 201
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-7000
Practice Address - Country:US
Practice Address - Phone:212-300-7069
Practice Address - Fax:212-731-0267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty