Provider Demographics
NPI:1457324832
Name:PHYSICAL THERAPY & ELECTROPHYSIOLOGIC SPECIALIST OF NY PLLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY & ELECTROPHYSIOLOGIC SPECIALIST OF NY PLLC
Other - Org Name:J P RICCELLI PHYSICAL THERAPY SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:RICCELLI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-697-6005
Mailing Address - Street 1:419 S PETERBORO ST
Mailing Address - Street 2:
Mailing Address - City:CANASTOTA
Mailing Address - State:NY
Mailing Address - Zip Code:13032-1431
Mailing Address - Country:US
Mailing Address - Phone:315-697-6005
Mailing Address - Fax:315-697-6006
Practice Address - Street 1:419 S PETERBORO ST
Practice Address - Street 2:
Practice Address - City:CANASTOTA
Practice Address - State:NY
Practice Address - Zip Code:13032-1431
Practice Address - Country:US
Practice Address - Phone:315-697-6005
Practice Address - Fax:315-697-6006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1671Medicare ID - Type Unspecified