Provider Demographics
NPI:1417179763
Name:NY PHYSICAL THERAPY & WELLNESS, EAST MEADOW, PLLC
Entity Type:Organization
Organization Name:NY PHYSICAL THERAPY & WELLNESS, EAST MEADOW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-222-2455
Mailing Address - Street 1:2088 FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554
Mailing Address - Country:US
Mailing Address - Phone:516-222-2455
Mailing Address - Fax:516-222-2459
Practice Address - Street 1:325 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1556
Practice Address - Country:US
Practice Address - Phone:516-222-2455
Practice Address - Fax:516-222-2459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025872-1208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ6WNK1Medicare ID - Type UnspecifiedPHYSICAL THERAPIST