Provider Demographics
NPI:1477939569
Name:NASSAU PHYSICAL THERAPY AND PHYSICAL THERAPY ASSISTANT AT NEW HYDE
Entity Type:Organization
Organization Name:NASSAU PHYSICAL THERAPY AND PHYSICAL THERAPY ASSISTANT AT NEW HYDE
Other - Org Name:PARK PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER / PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KAESTEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-322-9100
Mailing Address - Street 1:1204 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4607
Mailing Address - Country:US
Mailing Address - Phone:516-326-7899
Mailing Address - Fax:
Practice Address - Street 1:1204 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4607
Practice Address - Country:US
Practice Address - Phone:516-326-7899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy