Provider Demographics
NPI:1427204445
Name:STATEN ISLAND PHYSICAL THERAPY & REHAB, PC
Entity Type:Organization
Organization Name:STATEN ISLAND PHYSICAL THERAPY & REHAB, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:S
Authorized Official - Last Name:PESCE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-701-0626
Mailing Address - Street 1:116 ROYAL OAK RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-2519
Mailing Address - Country:US
Mailing Address - Phone:718-701-0626
Mailing Address - Fax:
Practice Address - Street 1:116 ROYAL OAK RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-2519
Practice Address - Country:US
Practice Address - Phone:718-701-0626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018380261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy