Provider Demographics
NPI:1447790845
Name:ROCKAWAY BEACH PHYSICAL THERAPY OF NY PLLC
Entity Type:Organization
Organization Name:ROCKAWAY BEACH PHYSICAL THERAPY OF NY PLLC
Other - Org Name:RBNY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATELYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CUSMIANI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-634-3211
Mailing Address - Street 1:11915 ROCKAWAY BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1970
Mailing Address - Country:US
Mailing Address - Phone:718-634-3211
Mailing Address - Fax:718-634-0926
Practice Address - Street 1:11915 ROCKAWAY BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-1970
Practice Address - Country:US
Practice Address - Phone:718-634-3211
Practice Address - Fax:718-634-0926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-03
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG100297792Medicare PIN