Provider Demographics
NPI:1487040473
Name:EMPIRE PERFORMANCE PT, LLC
Entity Type:Organization
Organization Name:EMPIRE PERFORMANCE PT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:TANZI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-225-2000
Mailing Address - Street 1:1611 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-1933
Mailing Address - Country:US
Mailing Address - Phone:845-225-2000
Mailing Address - Fax:845-225-5600
Practice Address - Street 1:2203 ROUTE 301
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-3434
Practice Address - Country:US
Practice Address - Phone:973-839-1003
Practice Address - Fax:973-839-3653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035424-1208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty