Provider Demographics
NPI:1487222923
Name:MBB PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:MBB PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BANAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-386-8686
Mailing Address - Street 1:6937 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7265
Mailing Address - Country:US
Mailing Address - Phone:718-386-8686
Mailing Address - Fax:
Practice Address - Street 1:6937 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7265
Practice Address - Country:US
Practice Address - Phone:718-386-8686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty