Provider Demographics
NPI:1497844823
Name:STEPHEN WIRTH
Entity Type:Organization
Organization Name:STEPHEN WIRTH
Other - Org Name:NEW YORK SPORTS & PHYSICAL THERAPY INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WIRTH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-520-3053
Mailing Address - Street 1:2339 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-2027
Mailing Address - Country:US
Mailing Address - Phone:516-520-3053
Mailing Address - Fax:516-520-5715
Practice Address - Street 1:2339 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2027
Practice Address - Country:US
Practice Address - Phone:516-520-3053
Practice Address - Fax:516-520-5715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ6WVX1Medicare PIN