Provider Demographics
NPI:1417239187
Name:EARLY STEPS PT PC
Entity Type:Organization
Organization Name:EARLY STEPS PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANISLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-809-7999
Mailing Address - Street 1:6735 YELLOWSTONE BLVD
Mailing Address - Street 2:4S
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2669
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6735 YELLOWSTONE BLVD
Practice Address - Street 2:4S
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2669
Practice Address - Country:US
Practice Address - Phone:718-809-7999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032233320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities