Provider Demographics
NPI:1437399797
Name:NORTH NASSAU PHYSICAL THERAPY AND REHABILITATION ,PC
Entity Type:Organization
Organization Name:NORTH NASSAU PHYSICAL THERAPY AND REHABILITATION ,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBHABER
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:516-484-0515
Mailing Address - Street 1:63 MINEOLA AVE
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2001
Mailing Address - Country:US
Mailing Address - Phone:516-484-0515
Mailing Address - Fax:
Practice Address - Street 1:63 MINEOLA AVE
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-2001
Practice Address - Country:US
Practice Address - Phone:516-484-0515
Practice Address - Fax:516-625-4546
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH NASSAU PHYSICAL THERAPY AND REHABILITATION, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4913225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ52602OtherMEDICARE PROVIDER ID